Challenges of older adults when a loved one was dying: Implications for nursing practice.

Aims: To explore the challenge of losing a loved one who was hospitalized at end of life and identify approaches deemed most helpful by older adult family members to resolve this challenge.

Background: Nurses will be caring for a growing number of terminally ill older adults and their families. Research specific to older adults to address their needs when a loved one is dying is necessary to promote quality family-oriented care.

Methods: A qualitative descriptive exploratory study was conducted with a purposive sample of 15 older adult family members during July-August 2015. Methods for data collection and analysis included story theory inquiry and theory-guided content analysis.

Results: The dimensions of the challenge of losing a loved one 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. 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 are the approaches to resolve this challenge.

Conclusions: Knowing a loved one was well cared for through nurses' compassionate caring was most important to older adults. Further research to address the self-care strategies of older adults as a loved one is dying is necessary. This study's nursing implications has the potential to enhance the quality of family-oriented care at end of life in diverse healthcare settings.