MAINTAINING TIES WITH THE DEAD
MAY HELP GRIEVING RELATIVES

	CHARLOTTESVILLE, Va., March 4 -- Maintaining a relationship
with recently deceased relatives is a good way to deal with grief,
according to a University of Virginia study.
Researchers also concluded that:
	¥ Caregivers of dying relatives are often confused about
how to deal with their own grief.
	¥ Family caregivers must work through three major stages --
or tasks -- that begin with the terminal diagnosis and continue long
past the death. 
	¥ Nursing intervention based on an understanding of the
tasks can ease the experience.
	Sponsored by a three-year, $422,817 grant from the National
Center for Nursing Research, U.Va. researchers studied grieving
African-American and Appalachian elders to help hospice nurses
understand the traditional ways in which these individuals deal with
death.  The study showed that many individuals do not know how to
grieve.  "When their loved one died, they were pretty much abandoned
by the system. We need to help them along,"said Richard Steeves
project director and associate professor of nursing.  "As nurses our
role is to be compassionate listeners." 
	Published recently in "Quality of Life -- A Nursing
Challenge," the study also showed that caregivers wanted to talk about
their loss, said Richard Steeves, project director and an associate
professor of nursing. Steeves, along with Marilyn King, now at the
University of Kentucky, studied 32 rural residents who provided
holistic care for terminally ill relatives.
	"Bereavement isn't a series of stages that people work through
sequentially, but a series of tasks that must be worked through
simultaneously," Steeves said.  "Relatives, as they care for and
eventually survive the dying person, work on these tasks, and their
quality of life is affected by the ease or difficulty with which the
tasks are engaged.  The tasks are not like fixing the faucet in the
bathroom, which can be completed in an afternoon; and once done is
done.  The tasks must be completed over and over and slowly until they
are accomplished, and the job is done."
	Task 1.  Relive the loss until the anger and pain are gone.
In some instances study participants talked with others over and over
about their loss.  "What we believe occurred is they were experiencing
a major disruption in the narrative flow of their lives," Steeves
said.  A diagnosis, such as cancer, and the terminal prognosis
abruptly stops the family life story.  "It is the narrative flow of
life in which meaning is embedded that has been interrupted by the
illness and the death.  Death ended that narrative, altering the
caregiving role."
	Recommendation. Nurses can provide space, time, and an
attentive ear for families to relive the traumatic events of a death
and the events that symbolize their relationship with the dead. Nurses
can be the audience family members need as they retell their story. 
	Task 2.  Reknit the social fabric of life. Reestablish a
supportive social climate or discover new family supports.  Funerals
are a way of reknitting the hole in the family that the death created. 
	"All the personal stories of the caregiver and the family have
come to an end and must be restarted in a changed form.  On the most
basic level, the family story needs to start anew because the role
assignments of the lost member have to be filled.  For example, one
participant who was in her 60s had never learned to drive. She had to
take on a new role or find a family member to replace her husband who
drove her," the report says. 
	Recommendation.  Nurses may be able to add to the stability of
the social world of a family by playing a pivotal role in the new
family structure.  A sense of a fractured or unstable social world is
increased if once a family leaves the health care system, members
never hear from any of the nurses again.  Post cards, letters or phone
calls are simple ways of increasing a family's sense of stability. 
	Also, nurses may be able to help a family by participating in
the rituals the family performs as it attempts to reknit the social
climate.  A letter or phone call on the deceased person's birthday or
on the anniversary of the death may help a family feel that the
rituals they are going through are shared with others, and therefore
more meaningful. 
	Task 3.  Work out a relationship with deceased family member.
When working out new personal stories, participants continued to
include the deceased in their cast of characters. The death merely
relegated the person to a new role. Some study participants reported
seeing ghosts, glimpsing familiar movements, or hearing the voice of
the recently dead person.  "On the most obvious and mundane level
almost all of the informants whose family member had died said that
when they were faced with a decision, they often asked themselves what
the dead person would want them to do," Steeves said.
	Recommendation.  Families in their struggle to establish new
relationships with the dead person often do so by processing the
memories of that person and collecting items that have symbolic
significance in their past relationship. Therefore, families may be
able to make use of the stories clinicians have to tell about their
love one.  For example the photographs nurses often take and
memorabilia they may have collected will be important to families in
their struggles with establishing new roles for their dead loved one.
	U.Va.'s bereavement program will use information from the
study to teach hospice volunteers how to assist family members as they
grieve. 
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March 3, 1997
	For more information, contact Richard Steeves at his home at
(804) 293-8210 or at work at (804) 924-0092.  Television reporters
should contact our TV News Office at (804) 924-7550.