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  February 5, 2001

Engler Studying How Parents Cope
with Children's Illness, Death

Armed with an assortment of ointments, bandages and a stethoscope, Art Engler hikes up a craggy hillside to a small concrete house tucked under a corrugated tin roof. He is greeted on the porch by a woman in her 20s holding a baby boy. They exchange a few words in Spanish, and Engler learns that the baby is having digestive problems.

Later, Engler will treat a little girl who has been cut after falling on a stick and a young boy who has a skin infection. Tomorrow, he will go door to door again, to help more families.

Engler, an assistant professor of nursing, is one of two medical providers giving health care to people in Colonia Episcopal, a small village on the north coast of Honduras that was washed away by Hurricane Mitch three years ago.

Since then, the people living there have had no local health care. Engler spent a month in the village last summer doing community health nursing through a program co-sponsored by the Episcopal dioceses of Washington, D.C., and Honduras. "It was amazing," he says. "The people were thrilled. They're so friendly, accepting and grateful for anything that can be done for their children." Now he wants to share the experience with UConn students.

Engler has planned a four-week program in Honduras for nursing students and practicing nurses who want to experience first-hand the rewards and challenges of community nursing in a developing country. The course will be offered through the College of Continuing Studies.

It's no surprise that Engler would cherish his experience and want to share it with others: He is committed to helping people.

Engler, who joined the UConn faculty in 1999, was a junior high school and special education teacher before deciding to go back to school to earn a nursing degree in 1979. "I worked as an orderly when I was in high school and college and always liked that kind of work," he says.

He went on to earn a master of science in pediatric primary care nursing and baccalaureate education from the University of Maryland in 1985, and a doctor of nursing science in psychiatric mental health nursing from the Catholic University of America in Washington, D.C., in 1999.

Engler began his nursing work in neonatal intensive care and has continued for the past 23 years. "It's the perfect area to work in, because it combines all the interesting parts of critical care and interaction with families and newborns," he says. He teaches two courses at UConn, commuting by air from his home in Washington, D.C., where he conducts research at Children's National Medical Center.

Engler's main areas of interest are parental grief and bereavement after the death of a newborn; parental stress when a child is admitted to the intensive care unit of a hospital with an unexpected, life-threatening condition; and the effect of Kangaroo Care (a method of skin-to-skin holding to promote parent and infant attachment for premature babies) on parental stress in the newborn intensive care unit.

His interest in families with critically ill infants began in 1980, when he began working in the neonatal intensive care unit at Children's National Medical Center. "I became aware of how uncomfortable most of my colleagues were dealing with families of babies in danger of dying or babies who had died and the families of those babies," he says.

He ended up establishing an education program for the staff, working out a protocol for dealing with the family around the time of death of the baby, and a follow-up program maintaining contact with the families for more than a year after the baby's death. "That's what prompted me to get into my doctoral program: I realized that I didn't know enough about caring for these families," he says. His doctoral dissertation focused on maternal grief in the year after a newborn dies.

Engler studied a variety of factors that have an impact on a mother's grief following the death of her baby. He found that the women who depended on emotion-focused coping strategies - like denial, escape, avoidance and blaming - had much higher grief levels than those women who used problem-solving coping strategies, such as seeking professional help, talking with a friend, or reading about the issue.

But many families who lose babies don't get the chance to talk about it, Engler says. "They say that people are uncomfortable with the topic; they don't know what to say. Many friends and family members have never even seen the baby, and the parents really feel isolated and alone much of the time."

He is now conducting research with a pediatrician at Children's National Medical Center on end-of-life care in the pediatric ICU, particularly on parents of children who have been admitted unexpectedly with life-threatening conditions, such as a near-drowning or a car accident. He is interviewing parents both of children who survived and of those who did not, about their experiences at the time of their child's hospitalization.

"We're finding out how parents coped and what the hospital staff did to help or hinder their coping," he says. "The goal is to improve health care everywhere."

Sherry Fisher

For more information about the summer course, Health Care in Honduras, contact Patricia Harkins: (860) 486-5985 or