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                <text>New understandings of parental grief: literature review</text>
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                <text>BACKGROUND: Health professionals have a critical role in supporting bereaved parents and rely on models of grief to inform and guide their practice. However, different models, based on fundamentally different theoretical perspectives and research paradigms, do not necessarily reflect the experiences, or particular needs, of bereaved parents. AIM: The aim of this paper is to report a literature review exploring changing theoretical perspectives in relation to parental grief in the United Kingdom and United States of America. METHODS: A literature search was conducted of nursing, medical and social science data bases using the key words bereaved parents, models of grief and theories of grief. This revealed 266 publications, of which 32 were relevant. Contemporary literature has formed the focus of this review but older material has been included to trace how theoretical perspectives on parental grief have evolved over time. FINDINGS: Theoretical perspectives, on which models of grief are based, have evolved continuously over the last century. Also, traditional and new models differ because in that they are rooted in positivistic and non-positivistic research paradigms respectively. The main implications for health professionals are that new models can be applied in practice to support parents in their grief. The literature reflects an Anglo-American cultural perspective and further research is needed to reflect the multicultural diversity of today's multicultural societies. CONCLUSIONS: This review highlights fundamental differences between traditional and new models of grief. Traditional models, place emphasis on bereaved people letting go of their emotional relationships with those who have died. In contrast, new models, place emphasis on parents holding on to their relationship with their dead children, and identify therapeutic interventions that support parents in their grief.</text>
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                <text>Using industrial processes to improve patient care</text>
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                <text>This article describes how epidemiology may be used effectively to provide hard statistical data upon which to justify and base the development of paediatric palliative nursing services within a defined locality. Through an analysis of mortality data this study identified the number of children and young people with life-limited (LL) conditions who met the criteria for paediatric palliative care (PPC) in South Glamorgan. Findings from this were then related to the provision of services, including nursing services, required to meet the PPC needs of children and those of their families within such a population. Outcomes identify the need for a multiprofessional/multiagency approach to care provision, including family nursing, respite and terminal care as well as postbereavement support. This study highlights how epidemiology may be used effectively to identify unmet needs and promote better systems of care delivery. Studies such as this strengthen the argument for nurses to cast aside what has been perceived as a hesitancy to use quantitative methods of research (Bonnell, 1999). Epidemiology, as a methodology, may now be deemed as yet another vital weapon in the nurse researchers' armoury aimed at providing evidence-based health care.</text>
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