How to help the Family of a Terminal Patient(1) .pdf
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How to help the Family of a Terminal Patient
It’s inevitable as a nurse to experience the loss of a patient. If the patient
has been cared for by you, the chances are you have become familiar with
not only the patient, but the family as well. From the moment a family and
patient are informed that the patient is terminal, you become not only the
nurse, but a support system for all involved. The doctor provides the
pertinent information to the family and patient, and then you are there for
follow up questions, and to see the patient and family through this difficult
Allowing Open Discussion
For many patients, it is important for them to discuss their wishes for their
loved ones, for after their passing. For the family members this can be
extremely difficult, and a natural reaction to prefer avoiding discussing the
terminal diagnosis. It's understandable from both sides, so if appropriate,
suggest a compromise. The family does not want to dwell on the inevitable;
however the patient needs to express their wishes.
A workable solution could be to allow the patient a certain amount of time,
an hour for example, to express their wishes upon their death. After that
time is up, close the subject until another designated time to discuss it, if
needed. Talking about the future continuously does not provide peace of
mind to anyone involved; however, it is only right that the patient make
their wishes known, a compromise of time may be the best solution.
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When they first learn that a family member is facing a terminal diagnosis,
most families will typically come together and rally their resources in order
to assist the ill family member. This is commonly referred to as the “unity”
stage of the new grief. At this point, other priorities are often pushed aside
and old grievances are put on hold as the family comes together. One or
more family members may emerge as primary caregivers, while others may
take on other responsibilities that were once carried by the patient.
Former family roles are often re-created and issues that may have been
buried long ago begin to rear their heads again. For example, people find
themselves falling back into old family roles, such as mediator or problem
solver, that they wouldn’t choose now or had thought they’d shed long ago.
This can not only take a toll on family members involved, it can be very
difficult for the patient. As an advocate for the patient, it is appropriate that
you speak up and offer suggestions.
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Gather information that you can provide for the family regarding resources
that may be beneficial to them. Counselors, clergies, grief experts, and
hospice care providers. Any resource that you, as the patient's nurse feel
could be of benefit to the patient of their family should be suggested. Your
primary concern will always remain with the patient, however, being
supportive of the family goes along with nursing a terminally ill patient.
What to Expect
First and foremost, expect the situation to be fluid. Also, expect everyone to
experience fluctuating moods as well as periodic changes of attitude, for
example, from a willing and eager helper to a resentful and reluctant helper.
Tensions can become particularly high during periods of remission, when it
seems as if everything is back to normal and at least some family members
want a respite from any added responsibilities they have taken on.
Family dynamics will dictate how the family, as individuals and as a unit,
copes with the situation. “Family dynamics” dictates the way a family
functions, including the unwritten rules it lives by and the roles that different
family members play. Some family members, for example, may feel very
helpless and feel the need to do something. The strains in the family system
that are caused by terminal illness first show up in the form of emotions that
family members may feel uncomfortable acknowledging.
It is not unusual for the stress created by chronic or terminal illness to
manifest in impatience, first, with the person who is ill, with fellow
caregivers, and with professionals. At this point everyone’s attentiveness is
stretched and their reserves of energy are depleted; therefore, everyone is
vulnerable to losing patience.
Be an example to the family members. Be understanding, and express how
sorry you are for what they are facing. Offering support when possible to
the family can go a long way in providing comfort for the entire family, and
ultimately the patient too. It's a difficult time, emotions are high, however,
in the end, the family will be gracious for your care and support as their
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