The bridge beyond: strengthening nursing practice in attitudes towards death, dying, and the terminally ill, and helping the spouses of critically ill patients.
Death and dying are often surrounded by a conspiracy of silence. Usually it is an unconsciously organised silence, leaving those whose lives are threatened by terminal illness or an accelerated death with a physiological insult and without much-needed communication. The silence seems self-protecting for relatives, medical and nursing staff. Silence is a false reassurance and offers no emotional growth or understanding of the events which surround death in its finality. People who fear death of a close family member often begin the process of grieving their loss before actual loss occurs, and can remain locked in grief for years unless helped by the right communication. According to Hampe (1975) this phenomenon is known as 'anticipating grief' or grieving. If medical staff and nurses are to feel confident in anything to do with death and dying, or to feel comfortable in dealing with terminal illness, they should have some understanding of death itself. They should also feel confident in opening up and maintaining an effective dialogue. This requires training in the relevant interviewing, assessment and counselling skills (Maguire, 1985). A systematic approach is necessary to provide good care for the spouses of critically ill patients, who may suffer anticipatory grief. Excerpts from a very helpful paper by Breu (1982) and an adapted care plan are included (with permission) at the end of this paper.