Palliative Care Nursing: Principles and Evidence for Practice

By Sheila Payne; Jane Seymour et al. | Go to book overview

22
Overview

Sheila Payne

Most books present death as a clear junction between being alive and being dead. Similarly, being bereaved is regarded as a state that occurs following death. Therefore, the discussion of death and bereavement is usually relegated to the final chapter of a textbook. In this book, we have chosen to devote much more space than other nursing texts to loss and bereavement. We regard death not as a single event, but as a process in which nurses often have an important role to play (Quested and Rudge 2003). They manage and orchestrate the dying period, by controlling physical symptoms such as pain or a dry mouth. Nurses work by containing and shaping the behaviours of the onlookers, for example by calling patients' relatives, medical staff or chaplains to the bedside at key times. Nurses also help to transform the newly dead body, making it presentable to family members, by washing and dressing the body, removing clinical equipment and any evidence of last resuscitation attempts. I start, then, at the time of death, focusing on nursing work with the person who has died.

I then move on to discuss the impact of death on those who survive. Instead of explaining bereavement theories as entities to be proved or disproved, I regard them as discourses – ways of talking about loss and conceptualizing the experience of bereavement. I then review three major groups of discourses: those which arise from psychological or psychiatric understanding of loss; those which arise from theories of stress and coping; and, lastly, those which are derived from sociological understandings of transitions in relationships and social networks. There are, of course, many other ways to understand bereavement which are located within major 'world-views', such as the main religions or philosophical accounts of human beings. These are likely to be modified by the culture, social class and life experience of those experiencing the loss. I will emphasize that it is the experience of loss that is important in life-threatening illness. Importantly, families and friends will have encountered many losses throughout the person's illness. Bereavement may be thought of not as a single loss, but as a

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