Death of a Child at Home or in the Hospital: Subsequent Psychological Adjustment of the Family

Introduction

Pediatric expiry by cancer is a serious problem worldwide, with more 413,000 death caused in 2020 (The American Babyhood Cancer Organization, 2021). Annually up to 2,000 children under 15 years are diagnosed with cancer in Islamic republic of iran (Pakpour et al., 2019). Cancer is the 2nd leading cause of death in children under 14 in Islamic republic of iran. It causes about 4% of deaths of children nether five and 13% of deaths of children aged 5–10 years (Kashani, 2012).

Cancer causes physical, psychological, social, economic, and emotional reactions for kid and family (Zarit, 2004; Lu et al., 2009; Valizadeh et al., 2014) that children's reactions to these stresses include physical problems, low, feet, fear, behavioral, and communication problems, decreased self-esteem and social interactions, and retrograde behaviors that are affected by the child's developmental stages and adjustability, duration of stress, and Its intensity (Kirsch et al., 2003; Yahia et al., 2015) and imposes a heavy brunt of care on the family unit (Zaider and Kissane, 2010).

The death of a child due to cancer is a devastating event that leads to prolonged bereavement (Snaman et al., 2020), circuitous traumatic reactions to bereavement (Gilmer et al., 2012), dissolution of the zipper relationship with the child, and feeling guilty. Grief is defined as an internal experience in reaction to the loss of something loved and valued (Näppä et al., 2016). Parental grief is prolonged 5–seven and can intensify during significant periods (e.one thousand., holidays), a concept known as "regrief" (Gilmer et al., 2012).

Bereavement is mourning with a strong sense of loss and sadness that occurs with death and is a process in which life continues without the presence of the person (Pakseresht et al., 2018). These severe and prolonged reactions to grief are common amongst family members but sometimes can be debilitating (Lichtenthal et al., 2015). All people grieve differently; some need professional help while others are resilient in their loss and practice non crave special interventions (Näppä et al., 2016).

Numerous studies have examined the psychological challenges such equally depression and anxiety for parents with pediatric cancer (Kreicbergs et al., 2004; Kim et al., 2013), grief (Lannen et al., 2008), existential anxiety, identity, and spiritual challenges (Lichtenthal et al., 2015), guilt (Surkan et al., 2006), post-traumatic stress disorder, negative affect on copping, adverse effects on health, social interactions, and loftier levels of psychological distress that often crave professional person assessment and assistance (Gilmer et al., 2012; Kim et al., 2013). Parents who have lost a child to cancer, they feel that if they could prevent cancer or death, they oftentimes experience self-blame and guilt (Eslahkar et al., 2019). However, despite this misery, virtually grieving individuals practise not develop mental and or physical complications. A pocket-size number of significant other in the bereavement menstruum show increased take a chance for hospitalization and decease as well every bit depression, mental illness, and substance corruption (Näppä et al., 2016).

The presence of such symptoms, every bit well as the disease and its treatments side-effects, the loftier toll of handling, psychological and social consequences of the disease of the kid and family, crave comprehensive care in the form of supportive care. This type of care supports the family and those effectually the dying or deceased child (Pakseresht et al., 2018). Communication, continuity of intendance past caregivers, likewise as child's physical and mental symptoms management, which are very important for parents in the later stages of a child'due south life, are aspects of parental care during the bereavement menses before the child's expiry (van der Geest et al., 2016). Family unit support at the end of a child's life and afterwards death contributes to the bereavement procedure in families, equally well as providing an opportunity for the family to share their feelings with those who empathise them (Pakseresht et al., 2018). Attention to, emotional, physical, environmental and psychosocial needs are the criteria considered during family bereavement (Suttle et al., 2017). Despite this need, treat bereaved parents did not be widely x years ago, and pediatric providers might not have cognition, even when bereavement care programs exist (Spraker-Perlman et al., 2021).

According to a study, families who do not receive professional person bereavement care live in a state of prolong uncertainty and feet. However, in addition to complex responses to loss, many parents take responded to this loss in constructive ways (Eslahkar et al., 2019). Parental demographics, such as age, gender, race, and ethnicity, affect the grief experience and bereavement outcomes (Snaman et al., 2020). I study constitute that parents over 30 years old showed better psychosocial adjustment than younger parents following the death of a kid from cancer (Morrow et al., 1981). Reynolds et al. argued that grief and depression are normal emotions in bereavement, but that symptoms of grief resolve more slowly than medically treated depression (Reynolds et al., 2004).

Bereaved parents have identified a demand for improved bereavement back up, emphasizing the important office that the healthcare team and medical institution serve in their grief journeying. Despite this demand, care for bereaved parents did not exist widely ten years ago, and pediatric providers might not have knowledge, even when bereavement care programs exist (Spraker-Perlman et al., 2021). There is a wide variety of bereavement programs where services can include a range of telephone or letter calling programs, grief support groups (siblings or parents), or meetings with professionals to hash out the death of a child or be the results of the dissection (Widger et al., 2012; Yahia et al., 2015). Bereavement groups are believed to be benign as preventive interventions from social and economical standpoints. Participation is likely to be more acceptable and less threatening to potential recipients than professional interventions linked to psychiatry. Costs can exist low, since groups are commonly led past staff or volunteers rather than mental health professionals (Näppä et al., 2016). An feel not oft discussed among providers is the personal feelings of grief that may come when a patient dies. Although providers of all disciplines have varied encouragement in engaging with the experience that may exist personally felt when caring for those who are at end of life, the nurturing of individual cocky-care can be of benefit in regards to tenability and viability within such work (Jonas et al., 2018).

Among the developed countries, Uk has standards of bereavement intendance, published in 2001 (Kirsch et al., 2003; B. S. A. a and Care, 2013). In Iran, a special, targeted, and codification care program is non designed for a caring family unit bereavement, and families are practically abandoned after the decease of a child (Rassouli and Sajjadi, 2014). The only cases observed are limited counseling to families after the death of a child in some centers (Pakseresht et al., 2018), including the Sherwin Charity, which provides bereavement care for the family as a grouping therapy by volunteer psychologists, and Due to the lack of sufficient prove in assessing the need for these services, the country'south policymakers are not aware of the necessity and priority of such services (Knapp, 2009).

Since ane of the all-time ways to improve the quality of intendance is to identify the needs of the patient and family from unlike dimensions, examining the electric current state of bereavement care in the country from the perspective of nurses who have the most contact with the patient and family can be a step toward development of this blazon of care in medical centers.

Awareness of the needs of the kid and family during bereavement provides a unique care plan for each family unit and prevents wastage of time and money following unscheduled intendance. Therefore, the nowadays study was conducted to explore the bereavement needs of families of children with cancer from the perspective of nurses.

Methods

Design and Setting

In this present qualitative conventional content assay 15 nurses were selected based on purposive sampling. This arroyo is used in situations where in that location has been previous research on a miracle but it needs further description (Potter and Levine-Donnerstein, 1999). Participants were selected from pediatric oncology ward of Mofid Hospital in Tehran (As a referral center from all regions of the state) and outpatient clinic of Shafa Hospital of in Ahvaz (Table 1). The enquiry environment was the natural areas of employment or intendance in which report participants were routinely nowadays.

Table ane. Demographic characteristics of care providers.

Participants and Sampling

These were the fifteen official nurses in the pediatric cancer ward who had the most contact with the bereaved families and were selected based on purposive sampling. I of them was the headers. In the written report of Spraker-Perlman et al. (2021), 13 mourning parents participated in the report, which despite the minor number of participants, rich results were obtained in the study (Spraker-Perlman et al., 2021). The inclusion criteria was having experience in pediatric cancer wards for at least two year, Being formal and willingness to participate in written report. Exclusion criteria included reluctance to interview and its continuation, failure to deal with the bereaved families of children with cancer. The first participants were a 32-yr-old nurse who had 3 years of feel in the pediatric hematology department of Mofid Hospital in Tehran. This nurse had a close relationship with children with cancer and their families and provided consummate and comprehensive information almost patients and families to the researcher and was eager to conduct the interview.

The reason for choosing nurses instead of bereaved parents was that the nurses were in contact with families who had a kid with cancer at the end of life or all of bereaved parents went to the hospital. And then they could identify different needs in different families. While a mourning family unit could only share their special needs with us. Another reason for not choosing breaved parents was the lack of advisable mental conditions for the interview. Interviews with nurses were able to gain a professional perspective on the needs of bereaved families.

Data Collection

Semi-structured and face-to-face interviews were conducted by the commencement writer in 2018. The beginning author was a doctoral educatee in nursing who had learned the method of interviewing during her studies from professors and the inquiry team consisted of thesis supervisors and consultants who had sufficient experience in interview analysis. A guide to interview questions was prepared prior to the interview to gather comprehensive data. The interviews lasted between 15 and 45 min. All participants in this study were interviewed merely once. Before conducting each interview, the researcher, by attending the research surroundings, while introducing himself/herself and explaining the nature and chief purpose of the research, has identified the appropriate participant and while receiving written consent by specifying its provisions, the appropriate time and place agreed upon by the parties were determined based on the desire and preference of the participant. For the interview, the researcher introduced himself while explaining the master purpose of the enquiry. So the main question of the research was asked; "What is your experience in caring for families who take a child with cancer at the cease of life or accept lost their child?" What do you call back are the needs of bereaved families? Probing questions then arose from experience of participants due east.one thousand., "What did yous do as a wellness caregiver?" "Explain the electric current procedure of providing care for bereaved families" Was asked. Then the participant was asked to comment if they had whatever other points or questions. Interviews connected until information saturation. In this study, the needs of bereaved families at the end of child's life and too afterwards the child's expiry were examined.

Data Assay

In order to analyze the qualitative data, conventional content analysis was used. This method was proposed in 2005 by Hsieh and Shannon (2005). This approach is used in situations where in that location has been previous research on a phenomenon just it needs further description (Potter and Levine-Donnerstein, 1999). In the present report, the unabridged text of the interview was read several times until a deep understanding was obtained. Then parts of the text were identified, marked, and turned into the smallest significant units (code) based on the researcher's initial perception. In the adjacent stride, the parts that were marked were encrypted based on predefined codes. Each role of the text that did non fit into this initial encryption was given a new encrypt. The writer is inspired by other subject area-related studies for coding. For this purpose, showtime, the text of the files was entered into Word software and and then advisedly read several times while key phrases and sentences were underlined. And so the codes (the primary opinion of the participants) were extracted. The first level of the coding process began with identifying the meaning units, e.g., words, phrases, themes, and sentences that have specific meanings. And then the main concepts in each unit of assay were chosen semantic units (Tabular array 2).

Table 2. Conventional content analysis.

Rigor and Trustworthiness

The Trustworthiness of the data were assessed according to the criteria of Lincoln and Guba (1985). These criteria including brownie, confirmability, dependability and transferability. In this report, long engagement with data was washed past spending enough time to collect and clarify information, besides review the data by supervisors and consultants and was used. Furthermore, the data were carefully examined past an external observer. In social club to achieve the confirmability, all stages of the research, especially the data analysis in all directions were recorded in detail so that if another researcher wants to proceed research in this field can easily understand. The blazon of inquiry and the characteristics of the participants were well described in club to make a good judgment about the transferability of the readers.

Ethical Considerations

The present written report is part of the doctoral dissertation of the showtime writer of the study, which has been approved past the ethics commission of Ahvaz Jundishapur Academy of Medical Sciences with No.IR.AJUMS.REC.1394.764. Interviews and audio recordings were conducted after participants' awareness of the purpose of the study and informed consent. Participants were also reassured that the recorded data would remain confidential, and it was announced that they could be excluded from the report at any time "without any penalisation of sorts."

Results

A total of 400 codes were extracted from the interview assay. The coding process was a continuous comparative analysis and duplicate codes was eliminated and similar codes was merged. Three categories named "achieving peace," "abandoned family access to care," and "continuity of care" and nine subcategories were extracted (Tabular array three).

Table 3. Categories and subcategories.

Category 1: Achieving Peace

Although the health care team provides information and communication to the family, they ultimately adopt to choose options that provide peace. Participants considered the importance of providing peace for the family unit during the bereavement process. Subcategories of this category included "Spiritual and Existential Support," "companionship with the family," "Contact with other bereaved Families," "Support in passing and accepting bereaved" and "continuous empathetic advice with the family" that they were considered soothing by some of the participants.

Spiritual and Existential Back up

Based on participants' experience, spiritual and existential support has an effect on the sense of promise, value, purpose in connecting with others, and connecting to greater power in the child and family. ".Some people deny the illness of their child or family member due to the thought that it is a punishment from God. Sometimes their beliefs become so weak that they practice not believe in annihilation. When you want to convince them that this is not the example, your work is a heavy brunt." (Nurse 1).

"One of the mothers of a child with cancer in the tardily stages of midnight said loudly, 'God, you lot say you are more empathetic than my female parent, and then why?' A mother does not want her child to encounter her like this. then how do y'all desire my child to dice?" (Nurse 5).

"In my stance, the existence of a psychologist, religious counselor, chaplain in these areas where mortality is very high and very constructive. When you lot yourself have a strong conventionalities in this field, y'all talk to the patient who comes to y'all and you will realize how calm your patient is…. There were families whose patients were on the verge of decease. We easily persuaded him to sit down on his head and pray for him. Easily accepted" (Nurse nine).

Companionship With the Family

Families deserve to be accompanied during the bereavement menses and should be allowed to talk almost their grief. Sharing emotions during bereavement with a friend or loved one may non help because people often try to condolement and the bereaved person stops sharing emotions. Almost all participants in this written report emphasized the result of health caregivers' behavior and their companionship on increasing or decreasing family morale. In the participants' view, accompanying and talking to the intendance squad is more effective than accompanying those around them during the bereavement period.

"Allow'southward give the patients' companion more time and opportunity to see the patient in bed so that they can communicate more easily with each other. This is the merely thing that can exist done to provide comfort for them." (Nurse 3).

"Family unit members in bereavement period before death are such that they accept everything nosotros tell them and do not allow an unprofessional person from their friends or family to get too close to them. short our words are valid for them and, they like united states of america to accompany them" (Nurse 8).

Contact With Other Bereaved Families

Participants believed that having advice with families who have similar conditions in the bereavement period is efficient and comforting.

"We frequently find the contact numbers of families whose children have died of cancer, and nosotros tell bereaved families to call them and encounter how they cope. Yous do not believe that we oftentimes notice out that families are together, Befriending and helping each other to get dorsum to a normal life and even recollect about getting pregnant again." (Nurse 6).

"I wish that atmospheric condition would exist created in the hospital for families who are in the catamenia of bereavement to come together and talk to each other. Do you know that these families are ashamed to communicate with those around them because of their childish disease. Cancer It is a taboo for them. Simply if they see a family with the same conditions, their suffering may be reduced"…(Nurse 11).

Back up in Passing and Accepting the Bereaved

Support from family, social resource, and health care personnel tin be efficient in overcoming the bereavement stage and making it easier to accept grief, as well as reducing the burden of bereavement on the family unit.

"We accept to know if the bereavement keeps the family away from those around or non. Can the family do other children's chores to get to school? Or is his work messed upwards? Therefore, the family needs back up in the bereavement period to see all its needs." (Nurse 5).

"A patient who has died, we set up with colleagues to get to the grave of the child in groups. Then their families even get to the ward 6, seven, x, and 11 months later and appreciate how adept it was. We went through a hard time, but your memories are however in our minds" (Nurse fifteen).

Continuing Empathetic Advice With the Family, the Category

According to nurses' experience, establishing a skilful human relationship with the family unit after the kid's expiry can make the credence of death easier for the family.

"There are many cases where the personnel have communication with the families subsequently the child'southward death. In some cases fifty-fifty if the patient died 2 years ago, but the mother still calls in a state of denial and says, Tell me what happened that night. This connectedness tin assist the family to accept the decease of their child." (Nurse vii).

"Personally, I cannot communicate with them afterwards. At present a series of colleagues telephone call and talk, now they inquire, simply I cannot communicate at all, after this happens and goes away, I desire to call and ask how he is, I cannot. I can't practice annihilation with myself. I cannot at all. After this case, I can no longer communicate with my mother. 'It 's as if I do not know what to say to them,' which is why they're cutting off." (Nurse 4).

Category 2: Abased Family Access to Care

This category emphasizes the abandonment of the family after the child'south death. Co-ordinate to the participants' opinion, after the child's death, the family is abandoned, and no care is provided. This category includes "improving family self-control" and "Family Awareness of Terminate-of-Life Care."

Promotion of Family Self-Control

Family cocky-control involves professional advice with the family so that the family unit retains or acquires a sense of control over the state of affairs.

"Subsequently child's death, families are practically abandoned. A noticeable affair that they practise is supporting the family after death, for instance, they called the father of the family, and he said that 'Come here, I demand you.' They talk to them psychologically and calm them down." (Nurse seven).

"Families are confused in this situation and do not perform many of their roles in the home and customs properly. In these cases, information technology is amend to give families specific responsibilities and the nurse has the role of counselor in empowering the family." (Nurse 4).

Awareness of End-of-Life Care to the Family unit

Participants stated that families in the bereavement menses need to obtain information and training from the treatment team on pre-and mail-bereavement status direction and various end-of-life counseling. Most families had no proper method to control bereavement before and subsequently the child'south death.

"For example, I have taught many times, and I say that 'well, try to be calm and trust in God and practise not weep too much, because your kid hears your voice even in the terminal moment of his life' after a while, they go on the same routine equally before, and at that place is no change. There must be a preparation program that is taken seriously and they can be influenced past it." (Nurse 6).

"It should exist a training plan that is done seriously and families can exist affected past information technology. It seems that the grooming we are giving seems to have no consequence. Now I do not know, maybe it is considering of the fiddling time nosotros spend on them that I tell you, or because of the problems, or because it is likewise busy, I do not know, maybe for example the training should exist from Exist someone else who has an bear on" (Nurse 8).

Category 3: Standing Care

The development of a child with cancer is stressful. Family involvement in the disease and handling procedure leads to the reduction of resistance to issues. This can imbalances in life and the demand for care throughout diagnosing procedure of a child with cancer until the post-bereavement stages. This category includes "formal and informal family care" and "individualized care."

Formal and Informal Family Care

Participants believed that it was necessary to provide formal care by health care professionals, including physicians and nurses, as well equally informal care by family caregivers in the face of the bereavement process.

"It is true that nosotros do things for the family in the hospital which may at-home them down a bit. On the other manus, the main stage of their adaptation to this situation is when they go home and need professional people to exist with them." (Nurse 12).

"Many times, moms say that they telephone call Famila to ask how nosotros are, but now that they do not inquire, they all get sore. Hey, they say, wait what you have done, God has made you like this. Or they say, every time they telephone call, they say, 'How are you?' The illness is the same. I mean, in fact, there are a series of disorders that I feel are bothering the family and there is no breezy support for them, so official health caregivers should provide support at dwelling and in the personal life of the bereaved family unit" (Nurse3).

Individualized Care

Preparing for death, because the specific needs of each child and family unit, and post-bereavement care are integral parts of intendance.

"Families are very unlike from each other, one is rich, one is religious, and in short, they are dissimilar, and you practice non know how to conduct. For example, 1 day, I told a mother that there are charities that can assist the families suddenly, the female parent got angry and said, "Are we begging?" (Nurse 9).

"The wishes of the bereaved families may be similar in general, but they may differ from person to person. There must be an expert who knows what to say through which door to enter and how to guide them, considering they actually say something that only A team of experts tin can empathize their needs from what they say" (Nurse 12).

Discussion

In this written report, the bereavement needs of families who have a kid with cancer were explained from the perspective of wellness caregiver. The needs of bereaved families include the three categories of "achieving peace," "Abandoned family access to care," and "continuing care."

Regarding the category of achieving peace, based on the experience of the participants, during the bereavement period, the internal direction of the house suffers, and the family unit becomes paralyzed. Post-obit the pressures of illness and handling, the strength of the family weakens, and the process of life becomes difficult. So that in the confront of this crisis, they are constantly asking for help and support to maintain and strengthen their cohesion. The reflection of needing help is the need for spiritual and existential back up, companionship with the family, contact with other bereaved families, support in passing and accepting the bereaved and standing empathetic communication with the family. Many participants believed in calming the patient and family in the end of life and considered proper advice, too as the abeyance of painful aggression. Spiritual care supports a sense of promise, value, the purpose of connecting with others, and connecting to greater power in the child and family unit. Some participants believed that the remembrance of God and religious practices heal to reduce the child's pain and illness, just the possibility and back up are not provided in this regard. It seems that spiritual intendance for parents during a child's illness is necessary because they look to help in the trunk of religion. Nikseresht et al. (2016) as well recommended the utilize of spiritual and religious approaches as an efficient way to bargain with the stresses caused by cancer in Iranian society. Rassouli et al. also considered spiritual needs every bit one of the most important needs of Iranian cancer patients and their families (Rassouli and Sajjadi, 2014). In line with this, the results of a qualitative study showed that religion has known as the main theme of the supportive gene for pediatric cancer adaptation (Stanton et al., 2015).

Regarding companionship with the family, it can be said that nigh all participants in the written report emphasized the effect of wellness caregivers' beliefs on increasing or decreasing the morale of the child and family. Esbensen et al. (2008) suggested that professional staff spend more time listening to patients and paying attending to their interests. But Support from professional staff has been shown to exist necessary only when the family unit network is dysfunctional, with poor communication (Näppä et al., 2016). A review study by Laura et al. showed that one of the bones needs of families was caregiver communication skills with the family. In consist with the results of the present study, effective communication and method of telling the truth can have a positive outlook for the family (Kerr et al., 2004).

In the subcategory of contact with other bereaved families, participants believed that during the bereavement period, contact and communication with families with similar atmospheric condition are effective and comforting. However, during this catamenia, some communications are strengthened, and some are reduced. In improver, aspects of family communication such as sharing feelings, appreciating each other, listening, and expression skills are important, positive, and supportive. The bereavement groups seemed to produce positive effects which could non be captured by the chosen result measures, such as a deeper insight into the grieving process and a feeling of articulation experience in grief. It cannot be told how anxiety, depressive mood and grief would accept evolved in participants without the bereavement intervention. The results of Nappa study indicate that we as health care staff do not have to worry almost nearly of those persons who turn down participation in bereavement groups, every bit they show less severe grief and anxiety than others (Näppä et al., 2016).

Support in passing and accepting the bereaved was some other subcategory of achieving peace. The dissolution of the attachment relationship with the child causes severe anxiety and other negative emotions in parents. Parents may feel guilty about not being able to protect their children. Research emphasizes that bereavement is an injury that causes negative psychological and health effects (Rogers et al., 2008). Stroebe's study found that bereaved were more probable to commit suicide (Stroebe et al., 2005). Li et al. (2005) that the bereaved were at risk of psychiatric hospitalization, peculiarly the mother. The run a risk of a mother's hospitalization may continue for more than five years later on the kid's death (Candy et al., 2015). However, Lindemann stated in the 1940s that if normal grief is shared with professional person assist, it is possible to settle an uncomplicated grief reaction in 4–half dozen weeks (Näppä et al., 2016). Danish researchers have constitute that the death charge per unit of bereaved parents is higher than that of non-bereaved parents. Thus, bereavement harms social functioning and quality of family life (Li et al., 2003). Families bereaved by cancer also frequently struggle with isolation due to fear of burdening their back up network with their persistent pain (Hinds et al., 1997) and feel decreased social support over time (Lichtenthal et al., 2015).

Regarding continuing empathetic communication with the family, it can be said that according to the participants, after the kid's expiry, the families are practically abandoned and, no care is provided. Some health caregivers make limited telephone calls to bereaved families without written instructions. In a report, the satisfaction and uniqueness of the role of volunteers in care, from the perspective of the patient and family take been mentioned (Processed et al., 2015). According to the cultural and religious context of the land and the being of numerous charities, information technology can exist adapted to the prevailing condition (Rassouli and Sajjadi, 2014). While there is no right or wrong manner to child loss bereavement, the Australian Care Program helps families know which response is right or wrong and helps families to place when family members demand counseling and support (Palliative Care Australia, 2010). In Canada, research has shown that parents are constantly in demand of bereavement services equally part of their care. At that place is a wide variety of bereavement programs where services can include a range of telephone or letter calling programs, grief support groups (siblings or parents), or meetings with professionals to hash out the death of a kid or autopsy results (Widger et al., 2012).

The 2d category was abandoned family access to care. Regarding the sub-category promotion of family self-control and awareness of end-of-life care to the family, participants acknowledged that despite providing care, factors such as kid and family wandering in different areas of care, insufficient knowledge of medical resources, and spending too much time accessing services. The family faces problems that require coordination betwixt dissimilar levels of treatment to receive ongoing care. Consistent with the present written report, a written report aimed at assessing the data and health needs of immigrants with cancer showed that the well-nigh information needs of patients were access to information nearly healthier living and affliction control and management, including information needs related to diet, physical activity and pharmaceutics information (Riahi et al., 2016). Parents similar to be involved in treatment decisions and know the risks and side effects of handling. These cases are consequent with the results of the present report. It tin exist said that having information about the child's condition is essential for parents' peace of heed, feeling of being in control of the situation, staying optimistic and developing strategies that are in the all-time interest of the kid (Kerr et al., 2004). In line with the findings of the present written report, in a needs cess in parents of children with cancer, information needs were recognized equally a common need (Kerr et al., 2004). Moreover, a written report showed that parents highly rated involvement in determination making regarding care and treatment of their kid, although decision making during the palliative stage is acknowledged equally being extremely difficult for parents (Hinds et al., 1997). In addition, although parents perceive their decisions around their kid'southward care and treatment needs as representative of their child's needs (Van der Geest et al., 2014). There is evidence that parents' understanding almost their kid's prognosis may not always exist realistic (Wolfe et al., 2000). Therefore, involvement and support of health care professionals remain crucial (Van der Geest et al., 2014).

The last category of this written report was called standing care. Formal and breezy family care should be based on an understanding of the position of the family and the child in the family unit network, friends and community, interactions, and communication. Findings showed that having good relationships and sources of support from family unit and those around are factors in reducing the brunt of affliction on the kid and family, and the absence of these positive factors harms the child and family. Social care is defined as the provision of people whom a person trusts and feels respected. This type of support in stressful situations such as cancer diagnosis is considered an of import source of psychological back up (Processed et al., 2015). Despite families' gamble for poor outcomes, few bereavement follow-upward programs and formal interventions to back up them have been rigorously evaluated. A systematic review of studies on hospital-based bereavement programs concluded that such programs help families experience cared for, reduce their sense of isolation, and improve their coping (Donovan et al., 2015). The results of a report showed parents were positive well-nigh the collaboration betwixt the tertiary care, local hospital, and community health intendance professionals and highly rated the frequency of consultations with wellness care professionals from the hospital in the period earlier their child died, in the time catamenia betwixt their child's death and funeral, and in the period thereafter (Van der Geest et al., 2014).

Regarding continuity of care, before reported benefits of continuity of intendance, for case, reducing parental frustration and enhancing parents' conviction in quality of intendance could analyze why continuity of care during the palliative stage is related to lower levels of parents' long-term grief. In contrast with communication and continuity of care, Van der Geets study showed that the extent to which parents felt involved by health intendance professionals turned out non to be related with parental grief levels (Van der Geest et al., 2014).

Children and adolescents are in the midst of the procedure of concrete, emotional, cognitive, and spiritual development and take different needs depending on their phase of development, and their intendance should exist individualized. Their families too communicate in unlike ways, and their understanding of disease and decease depends on their child'south stage of development and experience. Therefore, many participants considered that family intendance based on their kid's evolution is necessary. However, research findings point that the kid's anxiety about hospitalization is closely related to parents' mental states. Parents' tendency to behave abnormally with a ill kid, giving the kid a special position, and existence vulnerable has negative consequences and leads to the child'southward secondary mental disability.

Conclusion

Dedication to providing excellent care during handling and into bereavement for seriously ill children and their family members is crucial for holistic, patient-, and family entered intendance. Parental grief is complex and support for bereaved parents is universally needed, albeit with individual differences (Spraker-Perlman et al., 2021). According to the challenges and needs of the family unit before and after the expiry of the child, the care team needs to pay special attention to the families of the bereaved patients. Therefore, it is recommended that members of the health intendance team be trained in assessing family needs, identifying risks from adverse outcomes, continuing care, and providing resources during bereavement. The needs of the bereaved family should also be addressed in their intendance program. The results of the present study tin provide broader bereavement intendance, just more studies are needed to clarify other experiences and families' perceptions of the needs of the bereavement period. Limitations of this written report included the impossibility of generalizing the results and the lack of cooperation of bereaved families to participate in the study.

Data Availability Statement

The raw information supporting the conclusions of this commodity will exist fabricated available by the authors, without undue reservation.

Author Contributions

MP: investigation, wrote the manuscript, and writing—review and editing. MR: conceptualization methodology and writing—review and editing. NR, SR, and SB: writing—review and editing. SM: projection administration, conceptualization, methodology, and supervision. All authors contributed to the article and canonical the submitted version.

Conflict of Involvement

The authors declare that the research was conducted in the absence of whatever commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this commodity are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any production that may be evaluated in this commodity, or claim that may exist made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

This commodity was part of Ph.D. thesis with Ethical Lawmaking: IR.AJUMS.REC.1395.746. Thanks to the participants, policymakers, and nursing experts.

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