DOI: 10.14457/tu.the.2021.1017
title: The conquering of grief in Thai women experiencing perinatal death: a grounded theory study

description: Women experiencing perinatal death may suffer losses and grief. Health workers need to help these women adjust to the losses and to prevent depression. However, how these women conquer the grief has been rarely explored in the northeastern region of Thailand (Isaan). Therefore, this study aimed to understand the response, explore the meaning of conquering grief, and construct descriptive theory to explain the process of conquering grief in Thai Isaan women experiencing perinatal death.The design of this study was based on a grounded theory approach. The criteria for eligible participants were Thai women experiencing perinatal death as follows: 1) aged at least 18 years old, 2) duration of 6 months to 2 years after experiencing perinatal death, and 3) ability to understand and communicate in the Thai language. The eligible women were selected by purposive and theoretical sampling, and all were given informed consent forms to sign. This study was approved by both the Ethical Review Sub-Committee Board for Human Research Involving Sciences, Thammasat University, No. 3 (ECScTU), and the Kalasin Provincial Health Office. The participants provided both oral and written consent to participate in the study by signing informed consent forms. Data collection was performed between September 2020 and March 2021 by in-depth interviews lasting 45-60 minutes each until the data were saturated. The final sample size was 25 participants. The data were analyzed by constant comparative analysis until saturation of the categories appeared, and trustworthiness was confirmed with the triangulation technique.The findings were as follows: (1) Response to experiencing perinatal death, including the following: (a) thought and feeling responses to perinatal death (inability to accept the loss, depression, frustration, powerlessness, worthlessness, and guilt) and (b) behavioral responses to perinatal death (self-neglect, avoidance behavior, and concealment from social criticism); (2) The meaning of conquering grief was reflected in the following two themes: (a) living in the moment (not dwelling in the past, returning to normal life, and focusing on living children), and (b) creating a new life (keeping the deceased in mind, and maintaining self-worth); and (3) construction of descriptive theory to explain the process of conquering grief. The process of conquering grief in Thai women experiencing perinatal death began when the women perceived the loss and grief caused by perinatal death occurring in their lives. Perception of loss and grief triggered the women to express their responses to perinatal death. The tough time they faced triggered the women to adapt themselves through the process of cultural cognitive adaptation (comprehension, adjustment, and cultural awareness) which helped the women accept their loss and led to the stage of conquering grief, which was a positive outcome that enabled the women to reach personal and spiritual growth. However, conquering grief from one stage to the next did not continue in a straightforward sequence of steps, but could return to previous steps, and the women might have needed to take different periods of time until they could adapt and accept the loss that had occurred and eventually conquer their grief. Furthermore, we found “cultural cognitive adaptation” to be the core category evident throughout all processes of conquering of grief from the first stage to the last. In conclusion, the results can be used for nurses to develop effective interventions promoting women to accept their loss and work through their grief.