The Divorced Family–Focused Care Model: A Nursing Model to Enhance Child and Family Mental Health and Well-Being of Doubly Bereaved Children Following Parental Divorce and Subsequent Parental Cancer and Death

Abstract

The experience of parental death concomitant with parental divorce occurs for 46% of Danish children and 50% of American children who lose a parent to death. This experience of loss and double bereavement compounds increased risk of mental health problems. The aim of this study was to explore nursing interventions for double bereaved children that promoted their well-being. A phenomenological–hermeneutic approach was used to conduct 20 interviews with nurses in family cancer care. Ricoeur’s theoretical framework was followed with naïve reading, structural analysis, and critical interpretation, resulting in the formulation of a new model of nursing care for these children: the Divorced Family–Focused Care Model. Four themes were apparent: (a) collection of information about family structure, (b) assessment of support needs, (c) initiation of well-being support, and (d) coordination and follow-up focused on the child’s well-being. The new intervention model has implications for health care education and implementation of health care policies.

Double bereavement, mental health consequences and support needs of children and young adults—When a divorced parent dies

“…Effectiveness of family support is positively related to cohesive family dynamics and mental health capital within the family worlds (Lundberg et al, ; Thastum et al, ). To reduce the impact of overload, it is essential for professionals to support both family worlds to cooperate in supporting the double bereaved children and young adults within them, to cope with the stressors they experience (Lundberg et al, ; Marcussen, Hounsgaard, Bruun, et al, ; Margaret Stroebe & Schut, ). Our findings suggest a priority for improving support opportunities from close relationships and professionals at an earlier point for double bereaved children and young adults so as to reduce the adverse impacts of the transitions and disruptions they experience overall.…”

“…It is known that positive and supportive parenting enhances children's mental health and ability to cope with the parental loss (Ellis et al, ; Howell et al, ; Kwok et al, ; Werner‐Lin et al, ). Nurses and professionals should consider the family structure of critically ill patients and how the family dynamics will affect the children when a parent dies (Marcussen, Hounsgaard, Bruun, et al, ; Russell et al, ). A family‐centred approach to targeted care for divorced families can be achieved through the use of our previously described “divorced family‐focused care model” to plan interventions prior to parental cancer death (Marcussen, Hounsgaard, Bruun, et al, ).…”

“…Children and young adults often want to be involved when a divorced parent dies of cancer, but they require support to enable them to cope flexibly while navigating an uncertain future (Kari E. Bugge et al, ; Werner‐Lin et al, ). The divorced family‐focused care model combined with the model described in Figure can support the understanding of divorced family‐centred care and bring the two family worlds together, enabling whole of family world support to target mental health promotion, early identification and early intervention for children and young adult mental health and well‐being throughout the deterioration of the cancer ill parent, and following parental death, and for the duration of bereavement (Marcussen, Hounsgaard, Bruun, et al, ).…”

“…The researcher's proximity to the field site and participants provided unique access to the relatives of core informants and enabled a depth of data collection through visiting some of the children's homes, and including interviews with stepparents and grandparents (Spradley, , ; Wadel, ). Fourth, we limited our focus to the divorced parental death experience, but acknowledge that there are other family structures that may encounter similar grief problems such as single‐parent families, stepfamilies and fully intact families (Marcussen, Hounsgaard, Bruun, et al, ; Russell et al, ). Finally, our study represents a Danish context indicating that the findings cannot be completely generalised to a wider international context.…”

“…Little is known about psychosocial support needs among children and young adults when they lose a divorced parent to cancer (Marcussen, Hounsgaard, Bruun, et al, 2019b), but it is known that long-term treatment of parental cancer and uncertainty about future life arrangements is associated with psychosocial problems among children (Ellis, Wakefield, Antill, Burns, & Patterson, 2017;Faccio et al, 2018). Important opportunities for health professional intervention may be at the time of initial diagnosis of cancer; during active and palliative treatment process; when preparing for death; and during the transition to new living arrangements and family setting following the death of a custodial parental (Bugge, Helseth, & Darbyshire, 2009;Werner-Lin et al, 2010).…”