Loss (Psychology)

The growing older adult population, their age-related morbidities, and lifelimiting
chronic illnesses increase the demand for quality yet cost-effective end of life
(EOL) care. Losing a loved one creates emotional turmoil, heightened uneasiness, and
EOL uncertainties for family members. Understanding the complex needs of family
members and supportive actions deemed most significant to them can guide nurses to
enhance EOL care, encouraging palliation and peaceful death experiences. This study
used a qualitative descriptive exploratory design guided by story theory methodology to
explore the dimensions of the health challenge of losing a loved one who had been in an
acute care setting during the last three months of life, the approaches used to resolve this
health challenge, and turning points that prompted decisions about a loved one’s care
with 15 older adults residing in a Continuing Care Retirement Community (CCRC) in
Southeast Florida. Theoretical grounding for this study was Watson’s (1988, 2002)
theory of human caring and Smith and Liehr’s (2014) story theory. Older adults’ stories
were analyzed through theory-guided content analysis. Themes that describe the health challenge include moving from painful holding on to poignant letting go, uneasiness that
permeates everyday living and precious memories, patterns of disconnect that breed
discontent, and pervasive ambiguity that permeates perspectives about remaining time.
Approaches to resolve this challenge include active engagement enabling exceptional
care for loved ones, appreciating the rhythmic flow of everyday connecting and
separating to get by, and embracing reality as situated in one’s lifelong journey. Failure to
establish normalcy, coming to grips with abrupt health decline/demise, and recognition –
there’s nothing more to do – were the turning points identified by CCRC residents. Older
adults’ vivid recollections of losing a loved one and willingness to share EOL concerns as
well as recommendations regarding support of family members who are facing this
challenge serve as invaluable guidance for improving EOL care for dying patients and
their family members.

Feminist theory has long criticized the hierarchical and oppositional thinking responsible for creating the basis of what counts as real knowledge. In questioning how and why the experience of enduring relationship with the dead is not imagined as real, this dissertation will draw from this theoretical tradition. This analysis involves a paradigm shift in thinking about the nature of relationship---one that posits these kinds of experiences as something other than either a psychological remedy to our grief or the requisite belief in the survival of the self. Feminist critiques of dualistic thinking become the cornerstone of Chapter One in order to get to the roots of how knowledge of enduring relationship with the dead gets denied. This chapter addresses the splitting responsible for the othering of death, the desire to flee it, and, by association, the desire to flee the body. This flight is predicated on a bounded and distinct subject who imagines it must separate itself from the material in order to survive. Imagining the body in this manner sets limits for making visible a relationship that endures with death. Dualistic thinking, the degradation of the body and the desire to flee it will also be the focus of Chapter Two as it looks at the dominant contemporary practices around what is done with the corpse. These practices work together to deny a dead body that matters and one important for legitimizing enduring relationship with the dead. While enduring relationship is made invisible through these hegemonic discourses and practices, there are, as I mentioned at the start, experiences that say otherwise. Chapter Three will suggest that the knowledge that comes with these experiences is one sometimes accepted and explored in popular culture. Popular culture may provide the reminder, but recognizing enduring relationship also relies on the willingness to bring to the fore the role, the value and the contribution of the corpse. The conclusion will offer some examples of what I call practices of proximity that recognize the corpse as central for the living.