Thesis (Ph. D.)--University of Adelaide, Dept. of Clinical Nursing, 1997? / Includes bibliographical references (leaves 349-369).

In later life, the death of a family member occurs most often after a challenging time of family caring. It denotes a dramatic event in families’ lives, and involves intense feelings for all. To date, bereavement has mainly been investigated as an intrapersonal process from the perspective of family carers or widow/ers. Little is known about families’ experience when an adult member has died. A review of pertinent literature located only six adult family bereavement studies, which exposed the importance of family cohesion, communication and emotion, and found that family characteristics denote the background from which families make sense of the death. Despite these insights, a dearth of research exists about families’ lived relational world after a death late in life. Such knowledge is needed to better grasp bereaved families’ life-world and to discern their capacities and adversities, which shape their support needs. The purpose of this hermeneutic-phenomenological inquiry was to disclose meaning patterns and practices of families living with the loss of a close other. It included ten bereaved community-dwelling families, represented by widow/ers (mean age 80y), adult children, in-laws and grandchildren (n=30). Family was defined as a situated, relational involvement by those who feel close, and living with loss was seen as a process of changing relationships. A combination of in-depth family group (n=21) and solo interviews (n=16) were held six to 23 months after the death, and field-notes were written. The thematic and narrative analysis, embedded in a hermeneutic movement, involved reading, reflecting, and writing about gleaned data, fore-understandings, and emerging insights. Findings revealed that families’ life with loss is a world shared, and a world apart. Families collectively looked back to weave the death into their family narrative, and in so doing, constructed a story of a good death, compared-contrasted it with other deaths and events, and situated it within their multi-generational family context. Families lived with their loss by sharing-not sharing interpretations and daily lives. They connected via remembering, talking, spend-ing time, and enacting presence, but they disconnected for a variety of reasons. Families moved forward by continuing or reconstructing their family being and doing. While some families faced upheaval, others continued with little change. These findings need to be seen as situated, temporal constructs of prolonged researcher-participant engagements. They yield insights into families’ world based on the accounts of ten traditional families. Even so, this study adds a much needed empirical family perspective on bereavement. Family relations arose as interplay of different, contradicting forces at play, which moved members together and apart in their daily lives with loss. As such, it supports family models that emphasize the multivocal, relational, contextual, and continuously shifting nature of family health. It revealed that families hold an inherent capacity to make meaning of the death and enact family thereafter, and understand their relationships as resource. Thus, families may not need professional therapeutic interventions to redress their “functioning” or to avert “adverse” outcomes, but health promoting and relationship-strengthening care and services. Nurses can be helpful to families by facilitating meaning-making, strengthening family relations in a way that values multiple voices at play, and by supporting family transition and caring in light of present concerns.