“Grief changes shape but never ends” – Keanu Reeves

It is hard to give a timescale for dying, so we tend to talk about the trajectory of death, and look at the pattern of dying rather than the duration.

The above diagram gives the archetypal trajectories of social, psychological, and spiritual wellbeing and distress in family care givers of patients with lung cancer. Bereavement care begins before the death and is not just about the actual dying phase or time around and after death. Grieving for the loss of a person with dementia is a classic example of this, but it is also present in other dying trajectories as the physical appearance of the person changes, and the physical debilitation that accompanies that process. Nurses can be play a key role in supporting patients and families through this, what can become for some, a complicated web of fear, shock and complete uncertainty. Sensitive communication is critical and staff need to be supported to increase their confidence in opening conversations and providing the opportunity to facilitate conversations that will gently prepare families for what is to come. Prepare for the worst whilst hoping for the best – is often the most helpful perspective to take.

A) Acceptance that whilst death, dying and bereavement is a part of life, each experience is a unique human experience

  • Assessment of each individual to identify those more at risk of complicated grief
  • Advance care planning will support bereavement care

B) Bereavement care is everyone’s responsibility

C) Communication that is timely, honest and empathetic is integral to supporting those in bereavement

  • Compassionate care throughout the persons journey for the person and those close to the person that displays respect and dignity

Please be aware of what services and support is available in your local area.

This resource is highlighting the need for all to take responsibility in ensuring bereavement care is recognised.

Death of a loved one

In his book ‘Love and Loss’, Colin Murray Parkes (2006) explains that when the death of a loved is predicted the grieving process starts before the actual death. This is particularly true in some cases of dementia, where the family grieve for the loss of the ‘person’ when there is severe cognitive impairment.

This highlights the need for nurses to have a greater understanding of the stress and distress of relatives as they watch over a loved one who is close to death.

The clip below demonstrates the complexity of bereavement.

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