1. Donnelly, Gloria Ferraro PhD, RN, FAAN

Article Content

Mr C was dying, and I was assigned to care for him by my senior seminar instructor. I dreaded the assignment. Caring for a dying man was a frightening prospect that I had managed to avoid to this point in my education. My subtle attempts to secure a different assignment went unnoticed or ignored by the instructor. I reluctantly reviewed the plan of care that included close attention to skin integrity, breathing patterns, maintaining the airway, and pain management. "Incorporate the family into Mr C's care as best you can," my instructor advised as she walked me toward the patient's room. "I understand that this is a very close knit family."


I was just completing morning care when the family arrived, or should I say descended-the wife, two adult sons, and a teenage daughter. I greeted them rather formally, told them that I had just completed morning care, and that Mr C was resting comfortably. I asked if there was anything that I could do for them or if they had any questions. It was as if I did not exist. All of the family members approached the bedside, and began to cry and call to Mr C. They touched his face, his arms, his feet. The bed sheets that were so neatly draped over the patient when I had completed care were a disheveled mess. Mrs C finally turned to me and said: "Please leave us. If we need you we will come find you!" I walked down the hall and recall thinking: "This family is disrupting the dying process. Mr C needs peace and quiet. Overstimulation might heighten his pain, might prolong his death-as if I had intimate knowledge of how it all really worked."


I walked by the room from time to time only to observe the entire family hovering over the bed whispering in the patient's ear. Just before noon the wife and two sons left; the teenage daughter remained with her father. I entered the room and asked the daughter how things were going. Her reply remains with me to this day: "My dad is leaving, and, as much as we want him to stay, we need to let him know that it is okay to go, that we will be alright. We might seem like pests but we're his family." Pests! I had treated this family like pests; I was ashamed.


Once past the shock of that innocent and eloquent statement, I confessed to myself that I resented the family's intrusion into my world of practice where I knew best what my patient needed. I quickly realized what my instructor meant when she said: "Incorporate the family." Families need to be an integral part of care whether or not we understand and accept their mores. Culturally based family rituals and practices deserve the interest, respect, and understanding of health care professionals. The authors of the focus articles in this issue of Holistic Nursing Practice (17:1) promote the notion of family-focused care through the life span. More and more formal caregiving responsibilities are falling to families. Therefore, nurses need to focus on how best to support families through health, illness, and life's greatest transitions.