This study is an Integrative Literature Review, and its organization was based on Souza et al. (2010). The Integrative Literature Review, as a broader methodological approach, allows a better understanding of the phenomenon by including various types of studies, including experimental and non-experimental studies, whose synthesis provides an overview of the phenomenon of interest. This expands the range of information about the study object, building a solid foundation for research analysis (Mendes et al., 2008; Soares et al., 2014; Whittemore & Knafl, 2005).

This review systematically followed eight steps for its development: (1) researcher training for conducting the review; (2) elaboration of the introduction; (3) formulation of the objective and guiding question; (4) definition and description of the method and establishment of eligibility criteria; (5) article selection from databases, and critical analysis and interpretation of the studies; (6) categorization, preparation, and presentation of results; (7) interpretation and discussion of results; (8) dissemination of the review (Whittemore & Knafl, 2005).

Souza et al. (2010) state that formulating the guiding question is the most important part of a review, as it objectively determines the studies to be included, the results to be analyzed, and the information to be collected, thereby contributing to the research objectives.

Thus, to better meet the study's design (Biruel & Pinto, 2011), the formulation of the guiding question followed the PVO model, an acronym representing Participants (condition or problem situation, participants, and context), Variables (study variables), and Outcomes (outcomes or results) (Silva & Otta, 2014). Following the PVO model, the constituent elements of the question in this study were P: the grieving process, individuals who lost a family member to COVID-19, and scientific productions; V: specificities in the emotional experience of the grieving process; O: emotional experience. Therefore, the guiding question used in this research was: What scientific evidence is available regarding the emotional experience of the grieving process for individuals who lost their loved ones to COVID-19?

With the aim of including a broad and diversified range of studies in the field, a search was performed in the electronic databases BVS-Pepsic, SciELO, Lilacs, and MedLine to identify existing national and international literature. Initially, a query of the descriptors was carried out in the defined databases. The following terms were cross-referenced: "luto" [grief], "COVID-19", "famili* [famil*]", and "psicologia" [psychology]; the asterisk (*) was added to encompass words with different suffixes, such as family or families, as suggested by the databases themselves. The descriptors were applied together and through search groups, using the Boolean operators "E" and "OU" in Portuguese and their variations "AND" and "OR" in English.

Carried out in 2021, the search did not set a publication timeframe since the topic emerged in 2020 with the onset of the pandemic, allowing only a short time interval for research and article production. The selection of articles was not limited to a specific language, as the researchers were interested in investigating worldwide contributions on the topic.

As inclusion criteria, articles were selected if they: (1) specifically addressed the grief experienced by family members bereaved by COVID-19; (2) were original articles published in national and international scientific journals, including empirical articles, theoretical studies, experimental reports, and review articles. Afterward, articles were excluded if they: (1) only addressed the grief of family members bereaved by COVID-19 as a secondary objective; (2) focused on grief in children and adolescents, due to the unique characteristics of this population, which would warrant a separate study.

Thus, a literature search was conducted on October 13, 2021, using combinations of the aforementioned descriptors. This search yielded 104 abstracts for analysis, excluding 20 duplicate works across different databases (16 from SciELO, 2 from BVS-Pepsic, 29 from Lilacs, and 77 from MedLine). After critically reviewing the titles and abstracts, 22 articles were independently selected for full-text reading by three researchers. All of these articles were included in the final sample for meeting eligibility criteria and being relevant to the objective and guiding question of this study. The steps for constructing the revised corpus followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, summarized in Figure 1.

All ethical principles and guidelines for the development of integrative reviews were followed, synthesizing the main results, focusing on the data that dialogued with the objective and the guiding question. Next, data collection was performed, and the gathered information was recorded using an instrument adapted from the one validated by Ursi (2005). The extracted data of interest included: article title, authors, year of publication, journal, language, country, database, and study types. The detailed categorization of the articles can be found in Table 1.

Subsequently, extracted from the sample, were the main results that allowed for the identification of scientific evidence regarding the grief process of individuals who lost their loved ones to COVID-19. Based on this, the studies were classified into the following Analytical Dimensions: (1) Peculiarities of COVID-19 illness and death; (2) Mental health complications and incidence of complicated griefs among family members bereaved by COVID-19. The first analytical dimension aimed to identify the elements and specificities of the pandemic context that resonated with the emotional experience of the grief process. The second dimension gathered sample evidence that made inferences about the complicating factors in the experience of this process, related to the specificities of loss due to COVID-19. Additionally, results were presented regarding the impact of this experience on the emotional health indicators of the bereaved individuals.

Among the selected articles, as categorized in Table 1, a prevalence of publications in the English language was observed, totaling 14 articles; seven articles were published in Portuguese, and one in Spanish. Furthermore, within the period of 2020-2021, it was observed that, regarding the country where the research was conducted, Brazil stood out with the highest number of articles, totaling eight publications, followed by the United States and Italy, each with three articles. Regarding the year of publication, the sample is evenly divided, with 11 articles published in 2020 and the remaining 11 in 2021. As for the journal of publication, the articles are distributed evenly across different journals, with only three published in the same journal, the Journal of Pain and Symptom Management.

Analyzing the types of research in the selected articles, a prevalence of non-empirical studies was observed, with 14 productions in this category, including theoretical studies, experience reports, and literature reviews. It is worth noting that theoretical studies were distinguished from literature reviews by the former's in-depth exploration of specific theories, while the latter aims to gather and systematize studies on a subject. Empirical research and experience reports were also differentiated, with the latter including descriptions of practices beyond data collection, encompassing the entire research process. Thus, the sample consisted of eight empirical articles.

After careful reading and analysis, the main findings of the selected works were extracted, revealing similarities in the results, allowing for their grouping and defining two Analytical Dimensions. The first dimension concerns the peculiarities of illness and death by COVID-19 that impact the experience of grief among family members, while the second dimension addresses potential mental health complications and the incidence of complicated grief resulting from the particularities mentioned in the first dimension. Therefore, all the studies are interconnected and enable the construction of a coherent and sequential analysis, as the specificities of loss can be precursors to complications in the grieving process.

Considering the findings, the situation of humanitarian disruption and the disorganizing effect of the pandemic is undeniable. It is observed that individuals are facing constant unpredictability and fear, enveloped in sensations of loss of control and helplessness. Additionally, there is often a supression of important elements for the grieving process, such as time for processing, physical embrace, and support networks (Lopes et al., 2021).

Due to restrictions on hospital visits for health reasons and the need for social isolation to combat the pandemic, the absence of family members alongside the sick person is a constant situation when it comes to COVID-19 illness. This factor, which begins from the moment of hospitalization and persists throughout the course of the illness, up to its final moment, makes it impossible to say farewell and prepare for death (Morris et al., 2020).

Moreover, family members experience poor communication with the healthcare team due to the complex medical language. They deal with a diversity of professionals who do not always provide consistent information. Also, there's the inability of family members to be at the bedside to assess the severity of the condition and better understand the communicated medical reports. All these are factors that can instigate distrust in families regarding the healthcare team and generate a sense of lack of control and powerlessness (Fundação Oswaldo Cruz, 2020a; Selman et al., 2020).

Furthermore, funeral rituals, with archaeological records of their practice since prehistoric times, provide time for the traumatic event to be processed and the loss to be assimilated as a passage. Moreover, they mark a state of mourning that legitimizes the importance of the loss and allows the bereaved to be supported by their social support network (Oliveira et al., 2020). Bromberg (2000) also emphasizes the importance of seeing the body, participating in the wake, and religious ceremonies for all family members to facilitate the adaptation to the loss.

Based on the dual process model of coping, it is asserted that the bereaved individual oscillates between two psychological orientations: loss and restoration. The coping process involves oscillating between these two dimensions, confronting one and avoiding the other. The oscillation between loss and restoration allows the broken bond to be redefined throughout the individual's life, providing a process of construction of meaning for the loss (Stroebe & Schut, 1999). When there is an absence of oscillation between loss and restoration, and the individual predominantly orients themselves towards one of these two modes of orientation, the grieving process may be impaired, and its reactions may intensify (Parkes, 1998). By analyzing the particularities experienced by family members in the face of loss due to COVID-19, it can be inferred that the oscillations between loss and restoration described by the dual process model of coping were traversed by impositions and specificities of the pandemic context.

Families bereaved by the novel coronavirus, when unable to see the deceased's body or participate in farewell ceremonies, are left with feelings of incompleteness and unrealness of the loss (Dantas et al., 2020). Thus, without the possibility of verifying the reality of the loss, the process of oscillation and coping is affected, resulting in an impaired experience of grief (Fuchs, 2018). Furthermore, in the face of the multitude of deaths in the COVID-19 pandemic, many within the same family unit, relatives express feeling "numb, emotionally dormant", experiencing something that surpasses their capacity for processing, which can lead to complications in the grieving process (Dantas et al., 2020).

The literature supports such difficulty in processing. According to Freud (1915/2010), in war situations, numerous deaths in a short period expose the finitude of human life. This reality is threatening and difficult to assimilate. This is because the individual, while alive, does not have the experience of death itself, which is why there is no inscription of such experience in the psyche. Thus, for Freud (1915/2010), one does not symbolize the death of the other or one's own; it cannot be imagined or easily conceived psychologically. In this sense, what assists the individual in symbolizing the loss lies within their own resources, constructed from experiences of reality, in an attempt to elaborate on that which lacks psychic representation (Ogden & Simmonds, 2014).

In his conceptualization of grief, Worden (2013) describes that the process includes the possibility of growth through experience and the restoration of equilibrium, so that it can eventually be concluded. For this process to take place, some tasks need to be accomplished. These tasks, however, may occur without a prescribed order. The construction of one's conception of the world, once validated by the deceased person, loses its original meaning, requiring the bereaved individual to fulfill what the author describes as the tasks of mourning, which enable adaptation to the new reality, namely: accepting the reality of the loss, processing the pain of grief, adjusting to a world without the deceased, and finding an enduring connection.

However, due to numerous deaths occurring within only a few days, combined with constant feelings of uncertainty and fear of getting sick, individuals have been deprived of sufficient time to process the losses experienced before new events occurred. This sudden influx of events, which creates a scenario woven by difficulties in gradually processing the experience, hinders the aid of a resource that Horowitz (1990) states is important for the grieving process: time.

According to Freud (1917[1915]/1996), grief develops gradually, requiring time and psychic energy from the bereaved, in a constant attempt to process and psychically represent the loss. Similarly, given the specificities of the pandemic context, as it is an illness that develops acutely, it can be inferred that the excess of events occurring in rapid succession and in a turbulent manner contrasts with what is considered ideal for the processing of grief.

Commenting on the literature on the subject, it is worth noting that Freud (1917[1915]/1996), in his theorization, makes it clear that grief is a normal and expected reaction to the loss of a loved object and should not be immediately considered pathological and subjected to medical treatment. It is expected to be overcome with time. However, this time, an important condition for the grieving process (Freud (1917[1915]/1996; Horowitz, 1990), has been hindered by the pandemic experience. In the current scenario, many families go through the illness, hospitalization, and death of one or several of their members within a short period (Mayland et al., 2020; Morris et al., 2020).

Given the particularities observed in the process of hospitalization and death due to COVID-19, it is worth noting that the literature on the topic of death points out the existence of risk factors for the development of complicated grief. These factors include sudden death, communication permeated by myths and taboos about death, the existence of simultaneous factors of emotional stress, the construction of a belief system involving guilt regarding death, as well as a political and social context permeated by stigmas or catastrophic fears. Among other factors, a lack of knowledge about the prognosis and the physical absence of the family member alongside the patient is also present (Bromberg, 2000).

Therefore, due to the mental health issues triggered by inherent peculiarities related to illness and death from COVID-19, strategies have been studied and developed to care for the bereaved and prevent complications in the grieving process. Examples of strategies adopted in hospitals include conducting video conferences to bring patients and their families closer together (Fundação Oswaldo Cruz, 2020b), playing bedside audio recordings and reading letters in cases where patients are unconscious (Wang et al., 2020), and creating virtual memorials that provide a space to signify the importance of these deaths (Worden, 2013). Additionally, the communication between the family and the healthcare team is also a preventive strategy discussed in the literature, emphasizing the importance of preparing hospital teams to interact with family members (Fundação Oswaldo Cruz, 2020a).

However, it is important to note that despite the findings regarding the existence of particularities in the experience of loss due to COVID-19, which can influence individuals' grieving process, grief is also a personal experience for each individual. Although there are elements that bring people together, grief is experienced individually by each person, and it can develop in various ways based on the bereaved person's internal resources, past experiences, and the relationship that was shared (Ogden & Simmonds, 2014).

In summary, grief is a normal process of re-signification and elaboration that an individual must go through after losing something that was loved (Bousso, 2011). It is inherently present in human life through relationships with others, as a by-product of attachment and affection. Therefore, it is crucial to recognize its significance and provide care for the emotional complications that arise from experiencing this process, as grief not only reflects the relationship between the survivor and the deceased but also allows the bereaved person to continue living without their loved one while maintaining a constant connection.

In this research, it was found that the scientific production on the grieving process of those bereaved by Coronavirus infection has identified the presence of peculiar elements in the experience of loss due to COVID-19. Among them is the impossibility of caring for the ill, bidding farewell, and even receiving and offering condolences. Some families have experienced the difficulties of multiple deaths within the same family unit. At the same time, they experience guilt for disease transmission.

Through the analysis of the selected works, it was possible to observe a close relationship between the particularities found in the process of hospitalization and death from the virus and the possibility of complications in the grieving process, as well as mental health issues among the bereaved. Therefore, based on these findings and the literature used to connect them, it can be stated that the topic of complicated grief is an important aspect to be analyzed when it comes to death in the context of COVID-19.

Thus, it is suggested that new research gives voice to the experiences of family members who have lost their loved ones to COVID-19, so that the magnitude of the disease and the global impact of its effects are not forgotten. Furthermore, it is necessary for new research to address emerging strategies adopted by hospitals and institutions dedicated to supporting these families. This is because research aimed at preventing complications in the grieving process can benefit the reality of many families who lose their loved ones in healthcare facilities, extending beyond the scope of the Coronavirus disease.