Family Interactions of Terminal Patients

Family Interactions of Terminal Patients It is part of the job as a nurse that is difficult--working with a family that has a loved one at the end of life. 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 time.

Discussions 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 very 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, 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.

Related: Working as a Missionary Nurse Family Interaction When they first learn that a family member is facing a terminal diagnosis most families will typically come together and pull their resources in order to assist the ill family member. This is the 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. In “Saying Goodbye is never easy, however, families can find renewal through loss. As the family pulls together, living with the uncertain future, they may need advice on appropriate steps to take next regarding the care of the patient.

Even as the family comes together in this crisis there will usually be some initial signs that reflect the underlying upheaval that terminal illness creates.

Just living with the uncertainty that is associated with a terminal diagnosis is stressful, not only for the patient but for the entire family. Beyond that, there are the actual lifestyle changes it creates. Loved ones may initially

have willingly altered their own lives and shifted priorities to pitch in and accommodate the needs of the ill family member. However, that is only the beginning of a process that can extend for years. Over time, stresses and tensions will almost inevitably emerge from the family.

Lifestyles can get seriously out of balance as a consequence of added responsibilities. Established routines become disrupted and new ones may have to be added. Priorities may have to be realigned and the time devoted to them reapportioned. The impact of these changes may not be very noticeable at first, but eventually it can’t be ignored.

Many times family roles are often created during this time. One family member may be the designated decision maker, and speak for the entire family.

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Resources 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.

Expectations Expect the situation to be tense, and sad. Also, expect everyone to experience fluctuating moods as well as periodic changes of attitude, a willing and eager helper may turn into 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. Anger, resentment, and jealousy are the most common ones. Family members may feel guilty about having such feelings in a time of crisis and may try to suppress them.

But such feelings are normal and to be expected. Try as you may, these feelings will occasionally erupt. As dismaying as this may be, it is actually a

potentially healthy thing for the family as a whole because it gives everyone an opportunity to face reality, the stresses on the family, and to create new family dynamics that meet changing circumstances.

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. This is never an easy time for anyone involved, however as the attending nurse, you can provide some comfort in the fact that you are most likely the care provider, counselor, and sounding board for all of their needs.

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