Family System:
                   Anything that affects the system as a whole will affect the individual members, while anything that affects the individual members will necessarily affect the family as a whole.
                        To understand a family we need to consider:  Lifestyle, culture, beliefs, value systems, routine, resources and family dynamics.  The balance of a family is upset when family begins to deal with the realities of changes in their lives.  We must remember that their loved one is dying as well as the family unit as it has been known.
                        All families have distinct and characteristic styles.  Each one is unique where it falls on the continuum of a number of variables.  Family functioning greatly impacts how families cope with the transitions of a terminal illness.
 

Variables Influencing Response:
                                                Personality, sex, age, coping style, and abilities all influence how families deal with their loved ones illness and their own grief.  As well, so does their religion, philosophy, social, cultural and ethnic background and previous experience with loss and death, their intelligence, maturity and fulfillment in life.  There is also the quality and quantity of relationships, the degree of support and security provided by the relationship, specific fears, and the degree of openness and honesty of communication with significant others.    All these things shape and contribute to someone's response to dying and death.
 

Denial and Acceptance:
                           A balance between these strategies will enable the family unit to continue functioning with a sense of purpose and meaning while making necessary changes and the accommodations to meet the needs of the dying member.
 

Family Functioning:
                       Listening!!!!  Use judgment to determine if action is required or when intervention is requested.  Remember that the expectation that families will pull together to cope may be unrealistic.  Appreciate that they cope as well as they can under the circumstances.  Never forget that the family dies along with the patient.  The family as it is known now will NEVER be the same again.
 

Adaptation Tasks:
                   All families that are experiencing the loss of a loved one, as well as those that have already lost their loved one must learn to adapt to the changes in their lives.  Some of these changes include:
Fluctuating from denial to acceptance of the illness and death.
Establishing a relationship with the health care providers.
Meeting the needs of the dying person.
Maintaining a functioning family unit.
Living with the emotions of anticipatory grief.
Dealing with people outside of the family.
Anticipating the families new reality after the death.
Finding appropriate hope.
Making decisions for the dying person.
Allowing the dying person to be at risk.
Taking care of themselves and saying good bye.
 

Losses:
       When a loved one is dying or has died, the family and the patient must deal with so many losses.  Some of these losses include money, home, job, security, illness, death, disability, fertility, mobility, dreams and hopes... and sometimes even love.
 

Fear and Concerns of the Dying:
       There are also many fears to be considered.  These fears can be related to: Physical... the loss of independence, pain and suffering.  Emotional... the loss of identity, abandonment.  Social... the loss of relationships, roles in life.  And Spiritual... the fear of the unknown. They are also concerned with the increasing dependence upon others. The feeling of isolation from family, friends and loved ones.  They try to search for meaning.... what is happening to them, why, what is to be expected of this disease, how will it affect them etc.  They worry about the future of their loved ones.  What is going to happen to those left behind? hey fear the process of death... will it be long and painful, will death come swiftly, will they get to see their loved ones before they die, will their loved ones be present at the time of death etc., etc.  And afterwards....how will the loved ones cope? How will they survive? How will they go on?  They fear the anticipatory grief.  And they could be concerned with the needs of their family.  How will they manage without a decent income? How will they cope with the changing roles? How will they go on alone? Can they handle starting over?
 

Family's Needs and Concerns:
                                   The family also goes through fears, needs and has concerns.  Some of the things a family may be concerned about could include:  The need and desire to be with the dying person, especially at the time of death.  The need to be involved in the care of their loved one.  To be educated about the disease process.  To be assured of the family member's comfort.  To be informed of impending death... so that they can be at the side of their loved one at the time of death.  Family members also need to ventilate their emotions.  They need someone to talk to and may repeat their fears, concerns etc. over and over again.  They are concerned about their own personal needs and who will be attentive to those.  They need recognition of their personal stresses and need to receive comfort, support, acceptance from a support system including Health Care Personnel.  And most importantly they need to be allowed to grieve.  They are grieving their loss of relationships, hope, and their dreams for their future.
 

Simple Guidelines:
                       Here are a few simple guidelines for us to follow as you are supporting the family of the dying member.  Always remember that not all problems can be solved!  Don't try to be super-human and try to solve all problems.  They are not all in our control.  We, like the dying person, can feel helpless and insecure in our ability to help the dying person and their family.  The rewards of helping the dying person or their family can be minimal and uncertain.  Remember... you can't solve or fix everything!  We must be aware of our concepts of death, dying and living.  Not every one agrees with the way you think of or view things.  Do not force your beliefs upon the dying person or their loved ones.  Remember and be aware of your own limitations.  You cannot change the outcome of things or spare emotional suffering of people or situations.  Be aware of how our own personal experiences will effect how we deal with the dying person or their family.  And keeping mind your own personal beliefs, fears, needs, expectations and ways of coping.  No two people are alike!!
 

Strategies For Support:
                                    Communicate acceptance and concern.
                                    Establish a trusting relationship.
                                    Encourage the expression of feelings.
                                    Give control to the dying person and/or their family.
                                    Help them to continue roles and relationships.
                                    Encourage communication between dying person and their family.
                                    Listen to family members to find out what they know, understand, imagine, fear and feel.
                                    Try to include the children and help the parents to involve them.
                                    Identify, legitimize, normalize and encourage feelings.
                                    Involve family in are of the dying person.
                                    Help to find ways other than distracting to cope with sorrow and fears.
                                    Help to redefine terms such as 'lose control' or 'break down'.
                                    Encourage flexibility.
                                    Realize differences in families and be realistic about what they can do.
                                    Help the family to express their anticipatory grief.
                                    Give the family control. Don't take that away from them too.
                                    Recognize individual strengths and weaknesses.
                                    Recognize limits of coping capacities.
                                    Enforce self care to the family members.
                                    People need permission and encouragement to be frightened and anxious.
                                    People need time to readjust and mourn multiple changes and losses.
                                    Help avoid a struggle between your expectations and focus on theirs.
                                    *If you are a caregiver and not a family member, acknowledge the importance of your role but never mistake it for being one of the family.