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Dealing with issues of Death and Grief


Diagnosis of a terminal illness in one of the family members can prove to be a very traumatic experience and eventually call for care to be given to the patient. This can be done either by the family members or caregivers at home, or by nurses in the hospital wards and hospices. It can be concluded that nurses and caregivers play significant role in the dispensation of palliative care to terminally ill patients as this is their primary role as compared with family members and relatives who may have to juggle between more than one activity and responsibility. Grief usually clouds a family member when they are given the news that one of their members has been diagnosed with a terminal illness, and thus they have a given time to live. Grief is defined as the emotional or affective process of reacting to the loss of a loved one through death. The focus is on the internal psychology of the individual. Common grief reactions include components such as numbness and disbelief, anxiety symptoms of depression that accompany mourning and recovery at the end of everything. Reactions can be seen as abnormal, resulting from trauma, pathologic and complicated. A sudden and unexpected death of a loved one results to a more difficult grief as opposed to a death that was expected for instance a person who has been sick for a very long time (Kayiwa and Mathews, 2005). Matters are worsened to know that the patient will undergo pain and suffering during their last times on earth and there is nothing that can be done about it but to try and reduce the pain by giving palliative care.

Palliative care can be given by family members at home or the patient can be admitted into a hospice and taken care of by nurses and professional caregivers. Services of professional counselors are also employed to counsel and give assurance to the patients and family members alike. This is important as it helps the affected parties to accept the situation that cannot be changed, but rather managed in a certain way. However, some families may choose to administer Euthanasia, that is mercy killing to the patient to help reduce the suffering, pain and misery that the patient is undergoing and also to eliminate the pain in the family members each time they look at the patient and there is nothing they can do but sympathize. However, with this option, there are legal repercussions and roadblocks that stand in the way and before the family get to administer it, a lot of court room visits will have been made. The manner in which a person handles their losses whether or not they seem significant has a great psychological effect, which in turn affects how they lead their lives there after. In the event that one is stuck into the loss or they ignore the feelings then they may pay the price in the long run. Shouldering the weight are the nurses and other medical caregivers who have to inform patients and their families of the impending death or even the death of their loved ones. There are need for skills and capability to perform this critical duty with significant success.


The issue of grief and general reaction of people to an impending death of close member of their families has not been the target of much research in the clinical disciplines. Much of the focus has been on the tangible and measurable aspects of the field. This neglect has been in the backdrop of families as well as patients who are uninformed of ways of coping with the unfamiliar situation. A case in point is the patients who are suffering from terminal illnesses like cancer. The bulk of the nurses and other medical practitioners working with patient who have a limited and specific time to live in hospices and other similar settings have their attention on their patients only and rarely on their significant others who are going through difficulty coping and adjusting to the soon to be loss of their family member and friend. Whereas, it is true that the terminally ill patients suffer the most, the family’s feelings and concerns are not to be ignored. Even when any practitioner, for example a nurse, takes some minutes to explain the situation or just talk to the family and friends of the patient they are hardly patient enough to acknowledge their fears and concerns. Most of them engage in what Callas, R. (2005) calls ‘masking of feeling.’ This he explains as the act of concluding and prescribing solutions to a troubled person, client or patient before getting to know how they really feel and what it is they need. This for example where a nurse or even a counselor tries to normalize and say things that will make a patient feel better without getting to know why they were feeling bad in the first place. Hughes, P.M (2001) states that a nurse should restrain from offering false comfort for example, saying that everyone has to die or equating the death to a blessing.

Problem statement

Loss and grief presents the affected people with overwhelming anxiety and sadness. It is even worse when the death of the person is predicted as is the case in hospices and ward with terminally ill patients. The family and friends go through desperation and helplessness as they watch the patient probably experiencing pain while there is nothing that can be done to help him or make the situation better. According to Wrenn, P. (2007) the anticipation of the death not just by the patient but also his or her family and friends is very distressing and can even lead to depression and other psychopathologies like anxiety and adjustment disorders. When going through grief, people can experience a series of physical problems including shortness of breath or even difficulty breathing, headaches, dizziness and nausea. Grief can also escalate causing medical conditions like heart diseases and diabetes. As a way of coping, most people may try to medicate the negative feelings by engaging in sedative alcohol substance abuse which may be detrimental to their health. Melnyk, B.M. (2005), states that encountering grief while working in the field of medicine is almost unavoidable. It is an issue that most nurses and even doctors ignore only to be caught unawares when they have to explain to their patient or their families that they have limited time to live. It is even worse when they have to report to the family that the patient is dead. This issue becomes a problem where the medical practitioners are not well equipped or knowledgeable enough to take their terminally ill patients or the family through the process of grieving. According to Callas, R. (2005), most nurses and even psychologists fail when they try to get quick fixes for the concerns of the grieving persons or try to avoid the subject altogether. This could be due to the fact the persons have not dealt with their own personal grief and thus the issue evokes unpleasant memories. Not dealing with one’s own grief and loss according to Wrenn, P. (2007) reduces their ability to help others deal with the same and often lead to burnouts and feelings of incompetency.

Purpose statement

In the light of the mentioned problems and concerns, it is of importance that medical practitioners, especially the help givers like the nurses, are equipped with skills that will enable them to take their clients through the process of grief successfully. Nurses should be recommended to go for regular trainings and refresher courses to ensure that they are thoroughly informed on matters pertaining to grief. It is also necessary that nurses develop an open mind and culture sensitivity because the patients come from different backgrounds with different ways of reacting to the death of their beloved ones. It is meant to help the families to get over their losses and to successfully go through the process of grief and thereafter lead healthy and meaningful lives. The target population in this project is the family and friends of the patients as well as the patients who know that they have a limited or even specified time to live and are therefore going through mourning and grief. The project aims at ascertaining the competence of the caregivers, like nurses, with an attempt to explore how the said competency can be improved. The project will also explore the options and alternatives available to the patients and their relatives that they can utilize to cope with the distress of the mourning process. The main aim is to reduce anxiety, physical and other psychosocial illnesses resulting from grief and loss and eventually reduce the burden and cost of treating the otherwise avoidable illnesses.


The question to be answered is whether the families of patients with terminal illnesses and those that are bereaved are taken with success through the process of mourning and grief and therefore report less anxiety, physical and other psychosocial illnesses. Among the family members and friends of patients who are diagnosed with terminal illnesses do the skills of the nurses, counselors and other caregivers help in coping with the distress arising from the loss and thus reduce the resultant physical, social and psychological problems? PICO Format: P- Family members and friends of the terminally ill patients; I- Skills and competency of the nurses and other caregivers; C- Options available to the families like joining support groups; O- Reduce the physical, social and psychological problems and the burden of treating them.

Literature Review

Nurses, counselors and caregivers play a vital role in supporting family members who take care of the terminally ill, infirm or disabled members of their family. The major examples of terminal illnesses that bring stress to the family include cancers, HIV/ AIDS, diabetes, accidents that lead to permanent disability among others. It is a given fact that the families of those with terminal illnesses like mental disorders are greatly affected by the condition of their loved ones. Families exist not only to provide practical help and personal care but also to give emotional support to their relative with a terminal illness. In this case, the affected patient is entirely dependent on the family members, and their well-being is directly related to the nature and quality of the care provided by the caregiver. It is at this point that the caregivers, nurses and also counselors chip in to give some form of support to the family members in this very heavy task. These responsibilities can bring significant levels of stress to the family members to an extent that their normal life is interrupted and replaced with taking care of the terminally ill members of the family. This requires a lot of their time, and of course their life will not just come to an end because they are caring for one of their loved ones. This exercise usually takes a toll on them till they resort to employing the services of nurses and or caregivers, depending on where the patient is being cared for. In the case that the patient is admitted in a hospital ward for the terminally ill or in a hospice, then the responsibility will be rested to the nurses to look after the patient and assist them to live a painless and comfortable life in their last days.

As for those terminally ill patients who are based at home and being given home care, this responsibility lies with the family members and in some cases caregivers are employed to perform this. In some cases where the patient is entirely over dependent on the nurses and caregivers, and the workload is just too much, for instance when the patient requires constant attention and vigilance, it can end up affecting their overall quality of life including work, socializing and relationships. Spanning the last few decades, research carried out on the impact of care-giving has led to an improved understanding of this subject including the interventions that make the difference. It has now been shown that developing constructive working relationships with the nurses and caregivers, and considering their needs be they personal, physical, emotional among other basic needs is an essential part of service provision for people with terminal illnesses who require and receive care from their family members.

The term ‘Family burden’ has been adopted to bring out the objective and subjective difficulties experienced by family members of people with long-term terminal illnesses. Objective burden are associated with the practical problems experienced by family members such as the disruption of family relationships and responsibilities, constraints in social associations, leisure and work activities, financial difficulties, and also a negative impact on their physical health, including experiencing of burnouts. On the other hand, subjective burdens describes the psychological reactions which family members go through, for instance a feeling of loss, sadness, anxiety and embarrassment in social situations, the stress of coping with disturbing behaviors, and the frustration caused by the changing relationship status. Grief may also be involved. This may be grief for the loss of the patient’s original personality, achievements and contributions, as well as the loss of family lifestyle. Unconscious hostility and anger may also develop in the process without the family members’ knowledge.

Professional counselors are trained to work with a person’s normal developmental conflicts, while other mental health professionals generally are trained to diagnose and treat pathology and work with dysfunctional behavior or chronic mental illness according to Nugent (1994). Furthermore, counselors help people with personal, family, social, educational, and career decisions. Duties are dependent upon the individuals being served and the settings in which they work such as school, career, employment, rehabilitation, and mental health. In the case of patients with terminal illnesses, these professional counselors mainly come in to help the patient cope with the newly diagnosed condition and assist them to adapt to their new health condition. However, according to research works carried out by Altekruse and Sexton (1995), and West, et al. (1988/1989), counselors and administrators reported that the main duty of the counselor of the terminally ill was to diagnose and treat. They advice the patients on the do’s and don’ts of their condition and also explain to them the beneficial lifestyles that they should embrace in order to have a good life, or what is left of it. Though in this case, the treatment will not result in patient recovery. They may also need counseling in order to come to terms with the new developments as their lives too will be changed completely. Counselors provide a leeway for the family members to embrace and accept the facts of the situation, and by doing so, they will contribute positively towards the care of the terminally ill family member.


Taking care of the terminally ill patients can be quite an uphill task, one that consumes both time and resources of the family. According to Wrenn, P. (2007) the anticipation of the death of a loved family member not just by the patient, but also his or her family and friends is very distressing and can even lead to depression and other psychopathologies like anxiety and adjustment disorders. On the other hand, work can be made much easier by the use of nurses and caregivers to look after the terminally ill. Some of the advantages of this approach to that of family members giving the care is that nurses and care givers are professionally trained for that task. They perform it to their level best and leave no room for relaxation. And since they have no blood relations to the patient, they do not develop a weak heart that sometimes family members do and consequently give up and lose hope at the situation. Nurses keep their calm at all times and are present on call round the clock. Since this is their duty, and that they are paid to give palliative care to the terminally ill, they put in all effort since this is no ordinary occupation.

Their highly trained skills and experience can enable them to take care if any arising situation and emergency. Their skills and training help them to diagnose, treat and advise accordingly, both the terminally ill patient and the rest of the family members too. However, these nurses and care givers experience challenges when executing their duties. They may get some form of stress while at work. Therefore, these issues should be addressed in order for them to be highly effective while carrying out their duties. Another aspect of the nurses and caregivers is that they should be adequately trained so that they are well prepared for the task ahead. If not, then they risk doing more damage to the terminally ill patient and their family members than help them during the difficult grieving period. Development of strong ties both with the patient and the rest of the family members is an important task done by the nurses and care givers since they interact most frequently with both parties. In this case, they act as channels for conveying messages and requirements mostly by the terminally ill patient.

When things get too much for a family to handle, they resort to application of euthanasia (mercy-killing) or physician –aided suicide. Usually this is done after much deliberations and discussions by the family and the patient, and only used as a last resort in extreme cases. The issue of mercy-killing has implicated several categories of its practices, some may be deemed legal and others illegal, while still others are a subtle combination of any of those categories. In the case of the ambiguous practices of the “right to die,” legal consequences become indeterminate since the right of an individual to privacy puts little access for state intervention. The issue on “right to die” has been the subject of strong exchanges of responses between lobby groups from both sides of the ideological benchmark. The pro-life group fiercely raises its battle against any legal means of terminating a life, however hopeless it seems. On the other hand, those that support the “right to die,” of which conception is “dying with dignity,” upholds a patient's right to a humane and controlled end their life (Moreno, 1995). Mercy-killing is commonly associated with practices of physician-assisted suicide. But this perception is just part of a larger picture. The difference between the two is the means with which both are carried out (Neeley, 1995). In most countries, practices of euthanasia and physician-assisted suicide have been deemed illegal. However, in some countries like Netherlands, Belgium, and some countries in East Asia, these practices are acceptable (Moreno, 1995).

Proposed Solution

Social support is a very complex aspect when it comes to handling grief. It consists of a variety of components in itself. Social networks, supportive environment are some of the components. Lack of social support can lead to negative mourning outcomes. It is both a health risk factor and a bereavement risk factor (Kayiwa and Mathews, 2005). According to Kayiwa and Mathews (2005), normal grief needs intervention. It gives rise to emotional reactions that include shock, disbelief and denial that occurs after death. A spectrum of interventions that cover prevention and treatment to long term maintenance care should be provided. Preventive measures should target all persons associated with the death, persons with known risk factors and people who experience symptoms for distress (Kayiwa and Mathews, 2005).

Formal treatment should be provided for those people experiencing pathological grief complications. The time limited approach may also be used as a solution. It lasts for nine to eighteen months and covers four to ninety minutes per session. It identifies families that face risk of poor outcomes. It focuses on improving communication, and conflict resolution. It puts effort to strengthen family solidarity (Santrock, 2007). Maintenance care as a form of support is recommended for people experiencing chronic grief reactions. Psychosocial treatment may be offered for complicated grief through diagnostic criterion. This involves exposure that is followed by cognitive restructure then exposure therapy and lastly supportive counseling (Santrock, 2007). There is an extensive literature that defines and measures dependent and independent variable. The implementation should take effect when the death of a loved one is reported.

Implementation Plan

The implementation process starts from observing whether the members of the bereaved family have been affected by grief. People are different and their response to bad news or disaster differs. Some people respond quickly and often at the very time they learn of the death of a loved one. Others respond slowly to the effect of the news. The grief may affect the latter group after the burial and even several days after that. The impact of the grief is another factor that requires keen observation. Some people are greatly impacted by the news that they develop grief at that moment in time. These kinds of people can pass out for some time. Other people take the impacts and go through them with ease. This is especially for people who may have lost a couple of other people before including some of their loved ones in their lives. They may seem not to be disturbed by the loss of a loved one but actually it has affected them (Santrock, 2007).

Observation helps to identify the members of the family that may have been adversely affected by the death. It also helps identify the way the death has impacted them. This may help in identifying how much grief one is facing and to what extent (Chesser, 2010). After observation, one should identify the appropriate support intervention measures. Different support intervention measures are given depending on the impact of the death of a loved one. There are members of the family who will suffer mild grief and there are those who will suffer complex and complicated pathological grief. Those who suffer mild grief are supposed to be given support measures that are not intense as those with complex and pathological grief. Identification will entail choosing the right support intervention and the resources that will come handy with the support (Chesser, 2010). According to Chesser, after identification, implementation is done.

Implementation involves the actual offering of the support. When implementing the support measures each individual must be taken as an entity. There are those who may require company, encouragement and assurance that life will go on even after the losing a loved one. These are the people who may have common grief. People who require intensive support measures are those that have complicated pathological and complex grief (Chesser, 2010). The news of the death of a loved one may have interfered with the normal functioning of their brain thus interfering with their emotions and socialization with other people. They may need serious counseling, therapy and medication. These people may need to be taken to hospital for a certain period of time or just remain at home and be treated from there. The resources that will be needed when implementing the help strategy are several. Money may be needed to buy materials to be used in the entire process and to cater for transportation purposes if need for traveling to the hospital arises. The counselor, therapist, social worker and medics may be required to offer their help especially for people who have suffered complex and pathological grief. When the implementation process is done evaluation has to take place.

Evaluation is very important in the process of offering support to people who are suffering with grief. Evaluation is important as it shows the relevance and progress of the support intervention. There are two forms of intervention namely, formative and summative. Formative evaluation is done at the beginning, in and during the support intervention process. The importance of formative evaluation is that it identifies the weakness of the patient at the beginning of the support process. It also tells whether the support intervention measures are creating a change or not. In the event that the support does not bring about any change, formative evaluation helps in modifying or changing the intervention for better results (Chesser, 2010). Summative evaluation is done at the end of the entire process to ascertain whether the support process has yielded any results. It helps to indicate whether the support has helped the individual or has done nothing. There are several resources that can be used in the evaluation process. Questionnaires are used to interview the members the affected person’s family about the changes that have occurred. Mental screening tools can be used to screen the mind of an individual who may have gone mad when he was grieved. This may be done to see if the person is responding to the support intervention (Chesser, 2010).

The legal concepts underlying the issue on mercy-killing include an intricate variety of concepts, some are distinct and some ambiguous. Some instances include the hastening patient’s death by withdrawal of medical intervention (passive euthanasia), providing them with the means to commit suicide (assisted suicide), intentional killing of a patient (active euthanasia), or accelerating the process of death by providing the patient with comfort care (palliative care). An ambiguous category of “right to die” is the physician-assisted suicide, which could be construed to be an overlap of assisted suicide and active euthanasia in which the participation of a licensed physician is active (Neeley, 1995). In any case, legal consequences following the exercise of mercy-killing may vary drastically. Some states have no established rules with regards to it; some may violate statutes; some may lead to confinement; some are legal; and some are constitutional. But the issue on the legality or morality of these practices involves also the level of medical situation of a patient, whether a terminal illness is the basis of the decision or another level of pain, deteriorating quality of living, or a mental suffering. Some proponents find little distinction amongst these exercises of the “right to die” (Moreno, 1995). But it often results in abuses of discretion and goes beyond societal and moral concerns, hence a need to establish a distinction amongst them in every situation where relevant decisions are crucial.

Dissemination Plan

Either a Subjective Intent Test or Objective test was applied. Under the subjective intent test, a patient's desire is discerned through any of the following; written documents which may include, but not limited to, Living Will, advance medical directives, or power of attorney; an oral statement; records of the patient's past behavioral patterns; and discernment of the patient's choice had he/she been aware of his/her prognosis. Many courts had ruled to give way to the wish of a patient to stop having the indefinite use of life-sustaining medical technology (Wennberg, 1989). In the Objective Test Objective test the patient's condition may justify the withdrawal of medical care. However, the possibility that an abuse and oppression may transcribe should compel the courts to give meticulous them. Some lower courts, therefore, have resorted to discerning what medical treatment a patient may choose had they been aware of their prognosis based upon the details of the present condition. Under objective test are two standards to be used when a patient had not left a clear indication as to his/her preferences. One is the “limited objective test,” under which the life-sustaining equipment may be withdrawn when trustworthy evidence shows that the patient would really have opted to refuse medical treatment (Moreno, 1995). The other one is the “purely objective test,” in which the medical treatment causes the recurrence of severe pain to the extent that continued administering of the life-sustaining treatment could be inhumane. Since objective test is invoked only when there is no indication of any subjective intent, it is does not overly cause burden upon the right of the patient to refuse treatment. It remains in question whether objective intent test answers attentively to the desires of the patient or instead bypasses the need for an expressed desire of the patient, which applies to the desires of the guardians, physician, or the court.

Some implications in the recent cases having to do with “right to die” suggest that the state may provide strict ruling that only “competent” expressions of the desire to refuse medical treatment may given the credit. This provision prohibits a minor or a mentally incompetent patient to exercise his/her right to refuse medical treatment. But in some states, variations in the objective test could give permission to such individuals to exercise their right to refuse medical treatment. In cases where incompetent patients explicitly express their desire to withhold a treatment, denial of the right may be deemed a violation against the Equal Protection (Wennberg, 1989).

Conclusion/ Summary

The diagnosis of a family member with a terminal illness such as diabetes, Cancer and HIV/ AIDS can bring grief to the other family members including the patient. Worse still is when the other family members have to cope with the news that one of their loved one has departed. In such cases, the family members have to find ways of dealing eith the grief that has arisen from these occurrences. In the case of diagnosis with terminal illnesses, the patient and family members have to find ways of making the patient comfortable and a less painful remaining life on earth. And for this, they need all the support they can get.

Support given to the grieving should be handled with great care and attention. People receive information differently and the information affects them in different ways. Therefore support services must be chosen carefully and ensured that they are relevant to the person who needs them. The implementation procedure must be carried out gradually letting the person regain their normalcy smoothly.

Discussions over euthanasia and physician-assisted suicide have always raised disputes between those that oppose and support these two examples of how to exercise the “right to die.” A life full of unendurable pain may compel those whose loved ones suffer it to think thoroughly whether the patient should have the “right to die,” yet that question may remain unanswered. The doubt on the exercise of euthanasia and physician-assisted suicide lies primarily on the fear that there might be some discrepancies in the decision-making of when and how it should be carried out. Some may ask as to the appropriate condition of the patient to give consent to “right to die.” Some may question the magnitude of pain an unresponsive patient feels to make it a basis to end his/her life through physician suicide. Perhaps, the best consideration is the accurate, if not approximate, determination of how much pain a patient feels.

Despite all these, a suitable way has to be found of caring for the patient, a way that is within the reach of the family and that will be very helpful to both the patient and the family members alike. The family may therefore opt to choose from the above discussed options namely home care, hospice care, euthanasia or even physician-assisted suicide, whichever they may deem fit for their condition.


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Callas, R. (2005) Dying and Grieving, Life Span and Perspectives. New York: Harper and Row Publishers.

Chesser, B. (2010). Seven Steps for Handling Grief: New York, Sunstone press.

D., Hosie, T. W., & Mackey, J. A. (1988). The counselor's role in mental health: An evaluation. Counselor Education and Supervision, 27(3), 233-239.

Hughes, P.M. (2001). Transcultural Concepts in Nursing Care. New York: Ronald press. West, J.

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Melnyk, B.M. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.

Moreno, J. (1995) Arguing Euthanasia: The Controversy Over Mercy Killing, Assisted Suicide, And The "Right To Die". Touchstone.

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Wennberg, R. (1989) Terminal Choices: Euthanasia, Suicide, and the Right to Die. Wm. B. Eerdmans Publishing Co, 210.

Wrenn, P. (2007). Coping with Loss and Grief. London: Routledge.


Definition of Terms

Euthanasia - involves the intentional killing of a patient suffering from a severe malady for the purpose of ending such. Also referred to as Mercy-Killing.

Physician-assisted suicide - involves supplying the patient with any means to hasten their death without actually killing them.

Research survey

A survey will be carried out in respect of this research. The total sample will involve 300 participants with terminal illness. The data for the survey will be measured, recorded and analyzed in a representative sample, which will be selected out of total population of samples. One patient with terminal illness and one with curable disease will be administered a specific program and the same will be implemented to the rest of the sample population. Following the completion of this project, the groups from different scale of illness will be compared with other classes of another scale. When a patient is comatose or in any way incapable of making one's own decision with regards to medical care, the role of others on behalf of the physically and legally incompetent individual, may the second party be a family member or otherwise, adds complications to the exercise of the “right to die.” The courts have adopted different standards to address the problems of comprehending the desire of an unresponsive patient for a medical treatment.


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