The unexpected death of a child is one of the most challenging losses as it fractures survivors’ sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process of participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n = 13), qualitative data from the application and assessment surveys (n = 35; n = 21), excerpts from the journals of some participants (n = 3), and email correspondence with some participants (n = 5). We categorized the results in three meaning units: (1) where does my story begin? The “both and” of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: “careful optimism” and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self. Lehmann OV, Neimeyer RA, Thimm J, Hjeltnes A, Lengelle R and Kalstad TG (2022) Experiences of Norwegian Mothers Attending an Online Course of Therapeutic Writing Following the Unexpected Death of a Child. Front. Psychol. 12:809848. doi: 10.3389/fpsyg.2021.809848
DOCUMENT
Background: end-of-life care is not always in line with end-of-life preferences, so patients do not always die at their preferred place of death (PPD). This study aims to identify factors associated with patients' PPD and changes in PPD. Methods: we prospectively collected data on PPD at four time points within 6 months from 230 acutely hospitalised older patients who were part of the control group in a stepped-wedge randomised controlled trial. Associations between patient characteristics and preferences were calculated using multivariable (multinomial) logistic regression analysis. Results: the mean age of participants was 80.7 years. 47.8% of the patients had no PPD at hospital admission. Patients previously admitted to hospital preferred to die at home (home versus no preference: odds ratio [OR] 2.38, 95% confidence interval [CI] 1.15-4.92; home versus healthcare facility: OR 3.25, 95% CI 1.15-9.16). Patients with more chronic diseases preferred the healthcare facility as their PPD (healthcare facility versus no preference: OR 1.33, 95% CI 1.09-1.61; healthcare facility versus home: OR 1.21, 95% CI 1.00-1.47). 32 of 65 patients changed their preference during follow-up, and most of these had no PPD at hospital admission (home versus no preference: OR 0.005, 95% CI ≤0.001-0.095) and poorer self-rated well-being (OR 1.82, 95% CI 1.07-3.08). Conclusions: almost half of the patients had no PPD at baseline. Previous hospital admission, having more chronic diseases and living alone are associated with having a PPD. Introducing PPD could make older people aware of PPD and facilitate optimal palliative care.
DOCUMENT
Different unexpected combinations between industry, local government, private participants, educational institutes and artists resulted past year in challenging opportunities for transitions in urban and rural areas. The power of art with the perspective of the artist approaching challenges evokes a chain of thoughts and (cascading) events, affecting systems. This results not only in innovative sustainable social &industrial products but also in change of systems. Panarchy is the paradigm of transition and change (Holling). Panarchy is interaction of countless interconnected and nested complex adaptive systems. Panarchy is the paradigm where small actions can have major effects for good or worse. It is to expect the unexpected. Panarchy holds the promise of positively changing the anthropocene. By being prepared we can anticipate upon unexpected emerging phenomena which can be used as leverage for creating change. SDG-labs are the environment where we can experiment and create new resilient concepts for adaptation to the antropocene. SDG-Labs have two aspects, the first is creation of concepts for change within the lab-setting, its content; the second is the process of organisation of the lab within its environmental and societal context. The Lab itself can be regarded as a complex adaptive system while the organisation of the SDG-Lab is within panarchy, acting on multiple levels and on different scales. Both faces, content and context, of the SDG lab have their own emerging properties. For facilitation of the SDG-lab we organised workshops where creative methods based upon TRIZ ("Theory of inventive problem solving") and CPS (Creative Problem Solving) were applied. TRIZ makes use of pre-established thinking patterns and proven abstract solutions to sets of abstract problems. TRIZ provides a toolbox for solving complex (wicked) problems. TRIZ uses the heuristics of intrinsic technological and societal evolution once a concept emerges. CPS is used for application of the TRIZ toolbox, by making concrete problems abstract and abstract solutions, concrete. TRIZ and CPS makes use of analytical and design thinking. Results of these workshops are emerged pre-concepts which have the potential to create change. Contextual settings of the SDG-lab determine its rate of success. Many good ideas perish in the “valley of death”, before they can realise their full potential. The contextual setting determines acceptance and hence increases probability of idea realisation. The action of organising SDG-labs generates curiosity, enthusiasm, resistance and other emotions with people and organisations. This lead to disturbances in panarchy, which is rendered in emerging opportunities that can be seized by imaginative people. Sarasvathy and Simon (2000) coined for this approach the concept of effectuation as an entrepreneurial principle for seizing opportunities which emerge from entrepreneurial actions in contrast to causation where managerial thinking obscures seeing opportunities. Effectuation is actor dependent where given specific means, choice of effect is driven by characteristics of the actor and his or her ability to discover and use contingencies. This approach is also recognised in innovation theory where the concept of “exaptation” is explored. Exaptation is the attribution of a new functionality to an existing artefact (or organization, scientific achievement, or
DOCUMENT
