Evidence-Based Practice Guideline

Kathleen M. Davidson, MN, BSN Edited by Deborah Perry Schoenfelder, PhD, RN The death of a family member is a moment that matters. Family members of nursing home residents have reported difficulty recognizing the dying trajectory and being unprepared when death occurred (Forbes, Bern-Klug, & Gessert, 2000). Length of time as a family caregiver did not predict preparedness for the death. Research now indicates that family members who are prepared for the death of a loved one through clear communication with health professionals are less likely to experience complicated grief responses (Hebert, Dang, & Schulz, 2006). A paradigm shift has occurred: Routine after-death bereavement support is no longer supported by empirical evidence (Neimeyer, 2004). Therefore, nursing homes, stretched for professional staff, should not allocate professional resources to after-death grief support programs but rather should educate and encourage RNs to prepare family members in advance of the death of a nursing home resident. In particular, RNs need to put greater emphasis on helping families “see what we see” and making the sometimes subtle, often-unrecognized, dying trajectory of a nursing home resident transparent.