MANAGING AMBIGUOUS LOSS in Dementia and Terminal Illness

A universal family task centers on resolving losses threatening family solidarity. Loss such as death is definite; clearly tangible and visible. Other loss such as deterioration associated with terminal illness can be ambiguous; i.e., appearing less real because it is indefinite and less clear. Lingering, incurable illness, such as AlzheimeKs disease, is extremely painful and stressful for family members as they endure the progressive deterioration and eventual death of their loved one. In such cases, the essence of self, individual personality, ceases though the person physically remains alive (Dolca & Aber, 1989). Such an ambiguous loss may be more complicated for family members to grasp, and thereby begin to resolve. As a result, ambiguous loss may constrain relationships and hamper family connectedness and restructuring. This article encourages nurses to confront the reality of grief and isolation families undergoing ambiguous loss typically experience. Employing a systems perspective, it prescribes stress management strategies that nurses can utilize with families faced with ambiguous loss. In my own nursing practice, I attempt to help such families renew a sense of inner strength to cope more effectively with present circumstances and their future iourney together. My goal is to validate family members' grief while instilling hope that they can successfully manage the disease processes. To enable them to release grief and master developmental as well as caregiving tasks, my first step is to offer my presence, joining with them to support their getting in touch with the ambiguous nature of their loss. Following Walsh and McGoldrick's model (1991), I seek to foster healthy adaptation by facilitating two family tasks: 1 ) shared acknowledgment of the reality of the situation and shared experience of the loss; and 2) reorganization of the family unit and reinvestment in other relationships and life pursuits. To this end, I offer information and guidance, encouraging and coaching family members to share perceptions and explore beneficial solutions for meeting individual and collective needs. It is often difficult for families to accept the reality of psychological death when the person continues to be part of daily existence. Loss within the context of life does not allow space and time for emotional detachment, or pursuits outside the family. Often my role is more about "being with" and less about "doing far/ with the intent of fostering affectionate connections and competency among family members as they readjust to changing circumstances.