Applied Nursing Research 26 (2013) 168–173

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Applied Nursing Research

journal homepage: www.elsevier.com/locate/apnr

Lives forever changed: Family bereavement experiences after sudden cardiac death
D. “Dale” M. Mayer, PhD, RN a,⁎, Anne G. Rosenfeld, PhD, RN b, Kathleen Gilbert, PhD c
a
Montana State University, College of Nursing
b
The University of Arizona, College of Nursing
c
Indiana University, Bloomington Applied Heath Science Department and School of Public Health - Bloomington

a r t i c l e i n f o a b s t r a c t

Article history: Aim: To describe the bereavement experiences of families who survived the sudden cardiac death of a family
Received 28 July 2012 member and identify meanings of loss.
Revised 17 May 2013 Background: Approximately 325,000 people experience sudden cardiac death (SCD) annually. It is important to
Accepted 20 June 2013 examine family experiences after SCD because of the life altering impact of death on surviving family members.
Methods: A descriptive design, using the qualitative method of narrative analysis, was used to analyze family
Keywords:
stories of bereavement.
Family bereavement
Sudden cardiac death (SCD)
Results: Five themes were identified across seven families: sudden cardiac death … boom; saying goodbye;
Narrative analysis grief unleashes volatile emotional reactions; life goes on … but never back to normal; and meanings in loss.
Qualitative Conclusions: This study adds to an understanding of family bereavement and findings suggest that providing
information about the cause of death and allowing family members to tell their stories are potentially
important interventions for clinicians who interact with bereaved families.
© 2013 Elsevier Inc. All rights reserved.

Cardiovascular disease is a leading cause of death (Xu et al., 2010) shakes or severs those taken-for-granted ‘realities’ in which we are
and many of these deaths occur suddenly (Neumar et al., 2011). rooted, and on which we rely for a sense of secure purpose and
Sudden cardiac death (SCD) is a broad term that encompasses connection” (Niemeyer & Sands, 2011, p. 10). This loss of connection
unexpected natural deaths, with or without warning symptoms, can interfere dramatically with established family routines and
resulting from a cardiac cause in persons without known non-cardiac habits that have previously provided a sense of safety and purpose
fatal conditions. It is estimated that the annual incidence of out-of- for the family unit. It is important to examine family experiences
hospital cardiac arrest is between 235,000 and 325,000 in the United after SCD because of the life altering impact of death on the
States alone (Neumar et al., 2011) and these arrests are often fatal. survivors (Worden, 2009).
Many SCDs occur in the community setting (Lloyd-Jones et al., 2009)
and often happen during individuals’ most productive years. Of
particular concern is the fact that the sudden death rate has increased 1. Theoretical Framework
and has been rising in younger age groups (Neumar et al., 2011).
The causes and circumstances surrounding a death influence a While early empirical research on bereavement focused on
family’s bereavement with certain types of deaths being more individual bereavement after the death of a spouse (Parkes, 2011),
challenging for survivors (Parkes, 2011; Worden, 2009). If the death more recently researchers have acknowledged the social context of
is unexpected, family roles and tasks are radically changed and bereavement (Nadeau, 2008; Niemeyer & Sands, 2011; Parkes, 2011).
surviving family members are challenged to live in a world “…that is Symbolic interactionism and family systems theory provided the
alien, unimaginable, and uninhabitable, one which that radically conceptual frameworks for this study as these theoretical perspec-
tives view the family as a system that interacts socially, while sharing
both symbolic and mental processes (Nadeau, 2008). Symbolic
interactionism focuses on the connection between symbols and
Author Note: This study was conducted as Dr. Mayer’s dissertation at Oregon Health
interactions (LaRossa & Reitzes, 1993), while family systems theory
& Science University and this research was supported in part by grants from Oregon
Health & Science University Dean’s Award for Doctoral Dissertation and Montana State views the family as a system in which individuals interact. These
University Helen Jacobsen Lee Endowment. complementary frameworks provide an understanding of family that
The authors wish to acknowledge the generous assistance of Dr. Judy Kendall, PhD, recognizes both the individual family member and the larger family
of Portland State University, who was involved with the development and conduct of system in which individual family members socially interact with
this research.
⁎ Corresponding author. Montana State University College of Nursing, 32 Campus
each other and have shared meanings. The sudden death of a family
Drive 7416, Missoula, MT 59812–7416. member not only upsets the family system, but also disrupts
E-mail address: [email protected] (D.“D.”M. Mayer). individuals within the family system.

0897-1897/$ – see front matter © 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.apnr.2013.06.007
 D.“D”.M. Mayer et al. / Applied Nursing Research 26 (2013) 168–173 169

2. Purpose 3.3. Setting

The purpose of this qualitative study was to describe the Family was defined as “a group of people, either living together or
bereavement experiences of families who experienced the sudden remaining in close contact with each other both at the time of the
cardiac death of a family member and to identify meanings of loss. death and during the time elapsed since the death, who self-define as
Interactions between health care providers and survivors will impact family” (Gudmundsdottir & Chesla, 2006, p. 147). Family interviews
a family’s grief response (Janzen, Cadell, & Westhues, 2004). However, were conducted first, included at least two family members, and
many health care professionals report a lack of education and skills to occurred in the participants’ homes. Long distances between family
provide family support at the time of death (Purves & Edwards, 2005; members occasionally required connection via speaker phone
Scott, 2007). Scott states that “despite compassionate efforts by (Families 1, 4, 5). At the conclusion of the family interview the
emergency personnel, the care and support of suddenly bereaved researcher scheduled appointments for individual interviews; allow-
relatives remains suboptimal” (p. 108). Health care providers need ing several days for transcription of the family interview. Phone
knowledge of family bereavement to structure supportive interac- interviews were used only if requested by participants with limited
tions with bereaved family members because sudden deaths leave an availability for another in-person interview (Families 3, 4).
impact on survivors and family systems.
3.4. Ethical considerations
3. Methods
This study was approved by a University Institutional Review
Board and all participants provided written informed consent;
3.1. Design
participants interviewed by phone were mailed a consent form,
which was returned prior to the interview. All names are pseudonyms
A descriptive design, using the qualitative method of narrative
and only the interviewer was aware of the participants' identity.
analysis (Riessman, 2008), was chosen for this study. This design
allowed participants to tell stories, knowledge was created as
participants shared their experiences with the researcher, and 3.5. Data collection
meaning and truth were understood through the experience of the
storyteller (Riessman, 2008). Data were collected from June to November 2007 and the first
author conducted all interviews. Since it was anticipated that
participants would ask about the interviewer’s own loss experiences,
3.2. Participants the study introduction included a brief description of the researcher’s
clinical and personal experiences with SCD. This acknowledgement of
Multiple recruitment methods were used, including health shared experiences of loss established a trusting relationship between
professional referrals, advertising, and snowball sampling (Lofland, the researcher and the participants.
Snow, Anderson, & Lofland, 2006), where adult participants were All interviews were digitally recorded and transcribed verbatim.
asked to refer other families who might qualify. The purposive sample The interview guide was written, reviewed by content experts, and
included seven families comprised of seventeen individual family field tested with one family that experienced the non-cardiac death of
members. The mean time since the family member’s death was 2.1 a family member prior to this study. As recommended by other
years. The deceased family members, all male, were between 44 and researchers (Gilbert, 2002; Nadeau, 2008), family interviews were
54 years old at the time of death (mean age of 51). Participating done before individual interviews. This sequencing allowed the
family members were between 22 and 60 years old at the time of the researcher to observe family dynamics and appreciate the families’
family interview (mean age of 41.8). Family relationships to the collective understanding of the death, before collecting data from
deceased were varied; five of the 17 participants were spouse, ex- individuals within the family. The interviewer inquired about the
spouse, or unmarried partners; other participants included children, death by first requesting, “Please tell me the story of __’s death” and
best friend and niece. Table 1 depicts details about participants and continued by encouraging participants to describe their bereavement
each decedent. experiences, e.g., “Can you tell me how as a family your discussed __’s

Table 1
Demographics Sample/Decedents.

Decedent Cause of Death Family Members Relationship to Decedent Time since Death

F 01 Mike (age 44) Ginny & Dave Unmarried partner, Best frienda 5 years
Ventricular Fibrillation
F 02 Ben (age 54) Betty & Bill Wife, son 3 years
Aortic dissection
F 03 Dick (age 54) Janet & Kim Sister, niece 1 year
Cardiac rupture
F 04 Brad (age 54) Debbie & Connie Sisters 2 years
Myocardial Infarction
F 05 Jim (age 52) Alice, Irene, Oliver & Alex Wife, step daughter, Step sons 1 year
Myocardial Infarction
F 06 Ron (age 54) Marie, Karen, & Jack Wife, daughter, & son 1.5 years
Ventricular Fibrillation
F 07 Bob (age 49) Diane & Ann Ex-wife & daughter 1 year
Cardiac arrest

Note. All names are pseudonyms.

a
Mike’s family included Ginny, his unmarried partner of 11 years, and his best friend and business partner Dave. Ginny identified Dave as “family” when she stated that she and
Dave had “the closest personal relationship with [Mike] outside of maybe his family – but even his family – he hadn’t lived near his family for a long long time” and she described them as
“family enough.”
170 D.“D”.M. Mayer et al. / Applied Nursing Research 26 (2013) 168–173

death.” Probing questions were rarely needed, since participants were the days preceding the death. Participants then proceeded to tell the
talkative and one person’s response often prompted additional death story, which provided the context for their bereavement
comments from others. Family interviews ranged from 90 – 150 experiences. Participants consistently structured the death story in a
minutes (mean 96 minutes), and individual interviews ranged from temporal fashion, including a clear beginning, middle, and ending.
45–90 minutes. Field notes were written after all interviews and the Each story included details that verified that the death was due to
interviewer’s thoughts were recorded in a reflective journal. It was cardiac causes, however, if such details were not included, the
determined that we had an adequate sample size due to the breadth interviewer asked about the cause of death. Family members
and depth of the qualitative data collected. occasionally exhibited signs of distress including tears, cracked voices,
and pauses; however no one became overly distressed or needed to
3.6. Data analysis terminate the interview.
Five themes were identified, the first four are related to family
Narrative analysis (Riessman, 2008) was chosen because it bereavement experiences and the fifth theme is related to meanings
allowed us to describe how the same event, the SCD of a family in loss: (1) sudden cardiac death… boom; (2) saying goodbye; (3)
member, may have different meanings. Structural analysis focused on grief unleashes volatile emotional reactions; (4) life goes on … but
how the stories were organized and structured, while thematic never back to normal; and (5) meanings in loss. Themes 1–4 are
techniques focused on content, or what was included in the stories illustrated by an exemplar story (Riessman, 2008) while theme 5 is
(Riessman, 2008). The use of structural and thematic techniques presented as a contrasting story.
allowed us to describe patterns across the shared experience of family
bereavement while also identifying differences in individual mean- 4.1. Theme 1: Sudden cardiac death …boom
ings (Riessman, 2008). Questions that guided the analysis included,
“Why was the story was structured this way?”; “What is included, and Most participants began with a description of a normal day, for
not included, in this story?”; and “What is the meaning of this story?” example, “Well, it was a Wednesday night” or “[It was] a work day at
Data were analyzed in an iterative fashion using a systematic least…” However this normal day went greatly awry when they
approach which included transcription, overreading, coding, theoret- received a late night phone call or found a family member dead on
ical memoing, field notes, and a reflective journal (Lofland et al., the floor.
2006). Detailed transcripts, which included non-verbal content such
as pauses, crying, cracked voices, and/or laughter, were developed by 4.1.1. A story of questions: why did the death occur?
the first author and all transcripts were verified. The first author read Janet and Kim (family 3) had questions after Dick’s death. Janet
and reread the transcripts as additional interviews were conducted. was aware of her brother’s recent visits to the doctor; she knew that
Overreading (Poirier & Ayres, 1997) was used to identify what was his medications were changed. Even with this knowledge, Janet was
implicit or unsaid. An inductive approach was used during coding and shocked when Dick died. Janet’s initial questions were related to the
the code list facilitated the examination of the data on a deeper level. cause of Dick’s death: What happened to his heart? When did he die?
As additional interviews were completed and coded, previous Why didn’t Dick’s doctor “do something different?” An autopsy was
transcripts were read, and reread, to ensure consistency and accuracy done and Janet and her daughter Kim talked with the medical
of codes across transcripts. Theoretical memos were written to link examiner, who explained the cause of death as cardiac rupture. Over
data with the interpretation. Field notes and a reflexive journal were time additional questions arose and Kim explained how they sought
used to understand how the interviewer’s observations, personal answers saying,
thoughts, and own loss experiences were influencing the analysis.
The medical examiner took a long time with us and talked to both of
3.7. Rigor us - he was very helpful he was very empathetic and took all the time
we needed - we even had to call him back a couple of times because
Trustworthiness was ensured by using criteria appropriate to we didn’t understand and he was – he was very helpful - very helpful
narrative studies (Riessman, 2008), and included the use of detailed in determining the date of death umm – I was impressed… the time
transcripts, prolonged engagement with the data, and member that he took and the care that he took in explaining…
checking. Detailed transcripts were used to examine not only the
words, but also the context, of the stories. When used together Janet described the value of these conversations saying,
thematic and structural analyses allow data to be examined
thoroughly. Throughout the analysis researchers compared similari- The doctor who did the autopsy, to be able to explain it, umm, so that
ties and differences within the stories, while remaining open to I understood why the heart failed, umm, like Kim said to understand
different interpretations. Regular meetings were held to discuss the that it was painless, it was quick… [because] there is that feeling of:
data, consider alternative interpretations, and seek consensus. The Oh I should have done something. But no, there was nothing [anyone
first author was responsible for all transcriptions, which promoted could have done]. I mean this was 30 seconds and over with…
immersion and prolonged engagement with the data. Member
checking occurred during individual interviews as the interviewer
sought clarification of data collected during family interviews. The 4.2. Theme 2: Saying goodbye
research team, which included members with experience using
narrative analysis as a research method, approached this study with Participants expressed that they were ill prepared to say goodbye
an awareness of our situation-ness and we acknowledge that our to their family member who died. Families consistently described
personal loss experiences and professional roles as teachers, nurses, some sort of ceremony after the death.
and researchers influenced the analysis.
4.2.1. A “cool” goodbye story
4. Results Ginny (family 1) intentionally included a story that she found
meaningful and important. Mike died of a fatal cardiac arrhythmia and
The interview guide directed participants to begin with the story of Mike’s body needed to be moved from the site of the autopsy to a
the death, but most participants started at an earlier point in time. different location for cremation. The distance between these two sites
They described their activities, along with the decedent’s activities, in was only a few miles and Ginny explained that the fee would be “600
 D.“D”.M. Mayer et al. / Applied Nursing Research 26 (2013) 168–173 171

bucks.” One of Mike’s friends asked Ginny, “Could we, could we just put blaming over the ensuing months. Alice’s daughter Irene described
him in my truck?” Ginny elaborated, her feelings in the first days after Jim’s death,
So [Mike’s friends] all went and got him and they took him down to
I felt really protective of my mother… and it was a total role
the river and drank beer and had a big sendoff and said goodbye.… reversal,… like I had to make sure she was eating… she just had no
While I want to finish this because I think it was so cool - so they all
appetite and she was really sad – obviously - and it was – just
took [Mike] down - five or six of them - they went down to the… river horrible to watch and I was alone… I can remember having to like -
[and] drank a bunch of [beer] …which is what those guys would drink
hold her in the middle of the night [tears and voice cracking] like
when they were a low-lifeing it when they didn't have a lot of money… she used to come into my room and just talk – and fall apart.
and they told stories about Mike and I bet they had him down there
two or three hours…. They invited me to go [but] I declined: a). It was
all guys and I think they needed their guy time - and then b). I had 4.4. Theme 4: Life goes on … but never back to normal
already said my goodbyes, and I was like no, I think this is your chance.
Then they took him to where ever they had to take him and that saved All participants commented that their lives were forever changed
me 600 bucks [laughter] and they were glad for the opportunity. in the instant when their family member died and reported changes
in daily routines, vacations, holiday traditions, and social and
Ginny concluded this story by saying, “But that was the part with recreational activities.
the moving the body and it was pretty cool…” Ginny also talked about
Mike’s memorial service saying, “a lot of people spoke including some of 4.4.1. A family farm story
his siblings and many of his friends and Dave spoke and [Ginny] spoke … Marie and Ron (family 6) lived on a rural farm with their two
eight or nine people [spoke].” Ginny elaborated saying, “well I felt children, Karen and Jack. Ron’s death of a fatal cardiac arrhythmia
compelled to say something, because I didn’t have a chance to say greatly disrupted all aspects of their lives. Marie and Karen
goodbye to him” and “I liked speaking in front of all [Mike’s] friends, you characterized Ron’s death as precipitating feelings of, “everything
know, and family and everyone was real supportive….” Dave added, “I stopped [pause] and everything changed, a lot, [and] nothing’s been the
just thought it was really significant and meaningful time to say goodbye, same since.”
you know…” Ginny spoke about sharing stories and memories with After Ron’s death there was no one in the family with knowledge
others, “I remember looking forward to the memorial service, because I of the day-to-day running of the farm. Marie described that since
knew I was going to hear all these great stories – amazing stories about the crop had already been planted the family had to immediately
Mike and all these memories – and dreading the day after… ” When decide about keeping the farm, selling the farm, harvesting, etc…
asked why she dreaded the day after the service she stated, “because I Son Jack explained,
knew that the – then the ceremony would be over and the telling of tales
[stories] and people would start to leave.” We all kind of had to change what our plan were and kinda – all of us
kind of had to get back here – we had a lot to think about because we
had the crop seeded and we had to figure out plans for the summer
4.3. Theme 3: Grief unleashes volatile emotional reactions
and working [the farm].
The death of a family member was a devastating loss for the
families in this study. The initial reaction was that of shock, followed by Jack dropped out of college and started farming. He talked about
various other emotional reactions at different time periods after the this change, “Umm, I feel like I’ve grown up a lot… compared to my
death including anger, guilt, depression, rage, apathy, and loneliness. friends and stuff. My friends just being kids and I had to grow up pretty
quickly. So running the farm; that was pretty tough.” Ultimately Jack is
proud of himself, his new role in the family,
4.3.1. A story of self-blame
Alice (family 5) felt responsible for not saving Jim when he died at And I feel proud to be doing what he did [farming] … he’d be pretty
home of a myocardial infarction. Alice explained, proud of me for being able to [run the farm] …I think I’m more
It must have taken like 15 minutes for the ambulance to get here… responsible now. And I think I can take care of myself a little better.
but then I have read later… he was probably dying through the
whole 15 minutes and I just didn’t know it and then I of course 4.5. Theme 5: Meanings in loss
blamed myself like completely…
All participants were asked if they were able to find meaning or
Even when ER staff members tried to reassure Alice she described make sense of their experiences since the death of their family
her feelings, member. Some participants were able to articulate meanings in their
But I just felt, I felt horrible. Like: Oh my God … he was trying to tell loss, while other participants struggled to express themselves. Some
me, but he didn’t, he didn’t tell me, he didn’t have any … I don’t know participants spoke explicitly of “living life differently” as a result of
that he had any classic, you know, he had no arm pain that he said their bereavement experiences. For example, Janet (family 3) said,
anything about, no neck pain, no chest pain…
Oh yea we have all heard it: Smell the roses, enjoy life while you can,
da da da, but until you actually, you know, have something that hits
Alice talked about her family having to witness this self-blame
you that hard, that unexpectedly, and if you don’t run away from it. I
saying,
mean if you really embrace the fact that somebody did die, you live
It’s been so overwhelming… I think that it’s been – I have been really life differently, you relate differently. Umm, you know, you don’t
confronting with - perhaps with my family… Well - it - perhaps with worry about: Did I get my 40 hours in [this week] you worry about:
my family… I was just caustic - you know - and so I know my kids did I do something good…
saw that … and I think that –it’s been hard on everybody…
Meaning is dynamic and telling stories of bereavement experi-
Blaming oneself for not saving the life of a family member was also ences may have changed meanings. Six of seven families talked about
cruel for other members of the family, who had to witness this self- “living life differently” after the SCD of a family member. Only members
172 D.“D”.M. Mayer et al. / Applied Nursing Research 26 (2013) 168–173

of family 7 struggled to identify meanings in loss; theme 5 is goodbye ceremonies included the number of people who attended,
illustrated with a contrasting case: the people who spoke, and the stories shared among friends and
family members. Since the SCD of a family member greatly disrupts
4.5.1. A story of unanswered questions the taken-for-granted security in the world, participants expressed a
Bob collapsed at work and was transported to a local hospital need to tell and retell the stories of their bereavement experiences.
emergency room (ER) where staff members kept the family updated Sharing stories together about the person who died was important for
until Bob was transferred to the interventional cardiovascular participants; however sharing stories of loss and grief are often
laboratory. After what seemed like an eternity, the family was notified socially unacceptable. In this study participants were thankful for an
that Bob “didn’t make it” and they consented to an autopsy. opportunity to share stories about their loss and appreciated having
For days the family wondered if a confrontation with a co-worker a an opportunity to talk together as a family about their individual, and
few weeks earlier contributed to his death and about his untreated collective, bereavement experiences.
high blood pressure; they felt guilty that Bob never went to the doctor. The findings of this family bereavement study support that
Waiting to learn the cause of Bob’s death was difficult and Ann bereavement is a very challenging and tumultuous time for surviving
explained saying, “it seemed like it took several days before… we found family members and participants reported a wide range of intraper-
out [the cause of death]… and that was a hard part.” It was only when sonal responses. The days, months, and years after the death became a
the death certificate arrived in the mail, which listed “cardiac arrest,” time of great change; change that was both unwanted and unplanned.
that the family learned the cause of death. The findings provide insight into the impact of such sudden and
At the time of the family interview, which was one year after Bob’s disruptive change. For example, the suddenness of the death did not
death, the family asked: allow for resources to be mobilized ahead of time. Support often came
from friends and family members who helped with day-to-day
activities and the myriad tasks of living. Life continued even as
So this cardiac thing – it all happens within an hour? Once it, once it
surviving family members struggled with volatile emotions. Findings
starts or something … is that [it]…?;” and “So for someone to drop
provide insight into the volatile emotional reaction experienced
like that, it means the - the heart isn’t beating?” and “Is there any
during bereavement and their impact on other family members. This
time frame, was this going on a week before he died…?
study supports that bereavement never ends, although the acute
shock, disbelief, and erratic emotional reactions which occurred early
Ann and Diane never had an opportunity to ask questions: there after the death of a family member did lessen over time.
was no physician to call nor did they speak with the coroner or Participants described efforts to reconcile themselves to the loss,
medical examiner. Unanswered questions were present one year after while also reconstructing a life in which the deceased loved one is
Bob’s death, thus limiting this family’s ability to understand why Bob absent. In particular, the family farm story depicts this movement
died and unable to identify meanings in loss. between coping with the loss of the family patriarch, while also
maintaining the daily operation of the farm. Immediate decisions had
5. Discussion to be made about the farm even as family members dealt with their
grief. This shifting between focusing on the loss to focusing on
Findings include persuasive and moving accounts of family reconstructing their life has been reported by other researchers
experiences after the SCD of a family member. The results support (Rodger, Sherwood, O’Connor, & Leslie, 2006).
current literature (Nadeau, 2008; Niemeyer & Sands, 2011; Walsh & The sudden death of a family member disrupts the survivors’ lives
McGoldrick, 2004) and contribute to knowledge, specifically an and drastically changes the family system. Family dynamics and
insider view of family bereavement. The focus on family bereavement family roles changed as college aged children provided care and
experiences strengthens the limited knowledge of grief and loss in the support to grieving adults. Young adults described returning home
social context of family. At the heart of family bereavement was the more often to provide family support and family members who lived
challenge of incorporating the loss into a life forever changed by the apart described needing to be together and communicate more often.
SCD of a family member, while still maintaining connections to this After a life changing event, such as a SCD of a family member,
important person. During bereavement, surviving family members bereaved survivors search for meaning on many different levels, ranging
took steps forward to build their new life, but these steps were from the pragmatic to the spiritual and personal (Niemeyer & Sands,
frequently interrupted by challenging periods of grief and sorrow. 2011). After a significant loss, the bereaved must relearn all aspects of
Through this process family members generally identified meanings the world, including not just the physical world, but the psychological,
in their loss. An ability to identify meanings in their loss helped emotional, and social world as well (Attig, 2011). Participants in this
surviving family members after the SCD of a family member. study demonstrated the importance of the social world, especially the
All participants willingly shared stories of their loss and reported family world, during this time. Addressing questions about why this
that they were shocked when they discovered, or were notified of, the happened, why their loved one, what can be done, what needs to be
SCD of a family member, especially when their family member was done, are all made easier in dialogue with other family members. The
asymptomatic or had no awareness of preexisting cardiac disease. results support current knowledge of meaning making as an important
Asking questions and receiving information about the cause of death process during bereavement (Niemeyer & Sands, 2011) and several
was important to all families. Some participants discussed how they participants expressed a newfound desire to help others.
came to understand the circumstances of the death while other Participants in this study also reported post traumatic growth
participants reported they were struggling with questions about the (Calhoun & Tedeschi, 2001) as a result of their loss. For example,
cause of death. Unanswered questions were especially difficult for family 6 was proud of their ability to operate the farm after Ron’s
surviving family members. Professionals who interact with bereaved death. Calhoun and Tedeschi identified the most common form of
survivors can, and should, provide clear and accurate information growth as taking place in one’s sense of self, in changed and more
about the cause of death and answer questions, while also recognizing connected relationships with others, and in a changed philosophy of
that this information may need to be repeated several times. life. Although these researchers stated that the post traumatic
All families mentioned some sort of ceremony which took place response is not always positive, evidence of increased sense of
after the death. These ceremonies were both formal, including personal strength and resilience, a greater sense of empathy with
funerals and memorial services, and informal, for example gathering others, and, in some cases, enhanced sense of meaning, was seen
with friends and families at special locations. Important aspects of among the participants.
 D.“D”.M. Mayer et al. / Applied Nursing Research 26 (2013) 168–173 173

This study supports that bereavement is an experience of such death… boom; saying goodbye; grief unleashes volatile emotional
magnitude and intensity that rarely is one prepared to fully compre- reactions, life goes on … but never back to normal; and meanings in
hend the meaning and cope with the emotional reaction that loss. Results contribute to an understanding of family bereavement
accompany the death of a family member. The sudden death of a family and support meaning making as an important process during
member leaves a lasting impact not only on individuals, but on family bereavement. Findings suggest that providing information about the
system as well. This study gives voice to bereaved families, who spoke in cause of death to bereaved families, and allowing family members to
a brutally honest fashion about their bereavement experiences. Since share stories of loss, are important components of clinical practice
bereavement is a universal experience this study provides clinicians and when interacting with bereaved families after SCD.
researchers with an insider view of bereavement which can be used to
support those suddenly bereaved by the death of a family member.
The results must be interpreted with the following limitations in References
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