In the case of the former of these groups, there is a demand for proper training and experience in helping family members face the practical realities imposed by the death of a loved one. Further, research demonstrates that many acute care settings are lacking in the capacity to manage these particular issues, failing particularly to make some of the most basic steps needs to help the bereaved face this difficult period. According to Murphy et al. (1997), a survey of area hospice facilities revealed that such settings were problematically deficient in the areas of preparation for bereavement. Accordingly, Murphy et al. report that "the facilities completed surveys about on-site services routinely offered by licensed hospice agencies. 55% of the homes sent sympathy cards after the patients death. 99% of the facilities did not provide materials to the family or primary caregiver on the grieving process or bereavement after the death. None of the facilities sent a letter after the patients death informing them of local, community, or on-site bereavement support group meetings." (Murphy et al., 1104) The article continues to indicate that among such facilities, a full 76% lacked any information which could be provided in the event that family members requested psychological counseling for dealing with bereavement.

As the research conducted here denotes, there is a need for nursing professionals who are both trained in the ability to address immediate bereavement needs and perhaps most importantly, to determine where it is appropriate to refer the family members to a bereavement professional. Thus, it is also of critical importance that the nursing professional be able to facilitate contact with such professionals.

Research attained on the subject of end-of-life care suggests that the contentment experienced by the bereaved will depend significantly on the nature of the care setting. Those healthcare contexts which are designed with intent to ease the comfort and experience of patients during the end-of-life stages would received significantly higher marks than those that were simply engaged in the life-function maintenance. According to the study provided by Hanson et al. (1997), those bereaved individuals surveyed about their experiences with the healthcare system during the end-of-life phases of a loved one, found overwhelming positive results in acute care contexts. The study reports that "asked to make positive or negative comments about any aspect of terminal care, 91% of comments on hospice were positive. Nursing home care received the smallest proportion of positive comments (51%). Family members recommendations to improve end of life care emphasized better communication (44%), greater access to physicians' time (17%), and better pain management (10%)." (Hanson et al., 1339)

In addition to demonstrating some of the key priorities of those in the support system of a dying loved one, there is an indication that those facilities which are specifically outfitted to prepare for death are also more likely to have healthcare professionals with the interest and training needed to help the family cope with the process of bereavement. This is not as much the case in long-term care contexts, where families have tended to express discontent with the availability of services, counseling and basic compassion. So reports the study by Murphy et al., noting that "the study demonstrated few grief and bereavement services for families of patients residing in longterm care facilities." (Murphy et al., 1104)

Patient, Family and Nursing Dynamics:

Ultimately, the research conducted to this juncture contributes to the overarching argument that the part played by nursing professionals in navigating the bereavement process is both significant and specifically limited. This means that there is an implicitly understood support role to be played by the nurse in providing the family with basic information, immediate support and emotional consultation, but that there is also a point of separation at which juncture, the bereavement support must be moved into the hands of others. This is supported by the report of nursing professionals themselves. According to Birtwistle et al., "ninety five percent of district nurses believed their role should involve visiting bereaved relatives/carers of patients they have nursed, but only 19% believed they should visit bereaved people when the deceased was not their patient." (Birtwistle et al., 467) Beyond this, the Birtwistle text reports that few professionals felt that beyond this visitation, continued contact with the family was necessary.

Research suggests that especially in instances where family members have played a part in caregiving, the relationship with the nursing staff...

This makes the nursing professional more likely to have an positively effective role in helping family-based caregivers approach a major transition in their lives. Indeed, such nursing professionals will be a first line of contact with a healthcare community that includes numerous resources for helping to navigate the process of bereavement. Evidence also suggests that such family members benefit considerably from access to these resources. According to the study by Schulz et al., "the average caregiver depression scores before the death were relatively high, with 43% of the scores indicating a risk of clinical depression. The depression scores spiked right near the time of the death, but they returned to prebereavement levels within 4 months. By 1 year, the scores showed a significant decline, and the number scoring at risk for clinical depression fell to 30%. Many of the caregivers reported preparing themselves beforehand for the death, and targeted bereavement interventions may benefit them as they care for the patient at the end of life." (Schulz et al., 1936) In addition to helping to provide such intervention, nursing professionals should be armed with information and access to professionals that specialize in such interventions.
As is understood as a basis to this discussion, nursing takes place in an extremely wide array of healthcare areas. As such, confrontation with bereavement is likely to take a wide array of incarnations that will impact how the nurse approaches those in need. As the article by Walsh (2008) remarks, "nurses' experiences of dealing with the grief that follows bereavement will vary depending on the clinical area in which they work. For example, nurses working in A&E may witness relatives experiencing acute grief as they face the sudden and unexpected death of a loved one. For community nurses, it is likely to be different since they will probably have visited the patient before death and may well continue to support the family in the early post-bereavement period." (Walsh, 32) In the case of our discussion, the acute care setting suggests a more regular confrontation with death. A focus on the end-of-life stages of treatment in such settings indicates that counseling and support through the process of bereavement will have begun in the approach of death. The nursing professional will be particularly trained in ways of helping family members and loved ones to prepare for and navigate through the difficult transitional period from end-of-life to death and beyond.

An often overlooked aspect of the bereavement process is that experienced by nurses themselves. Though death is a part of the medical profession, it is certainly not endured without taking its emotional toll on healthcare providers. Indeed, the very best of nursing professionals will help to ease the end-stages of the patient's life by serving in an emotionally invested capacity. Thus, the support which caregivers can offer to one another during the bereavement process is absolutely central. So is this demonstrated in the research by Bunting-Perry (2006), which remarks on the dynamic between nursing support and primary caregivers who spend a greater portion of their professional and personal time with a single patient. The article by Bunting-Perry reports that "the caregiver may be exhausted from providing years of physical and emotional care. Many caregivers have invested so much of themselves in the caregiving role that they are socially isolated and have few support systems to assist them through bereavement." (Bunting-Perry, 106)

This means that an important dynamic through which support should be availed is that between healthcare professionals. The important role that the primary caregiver plays in helping to bring comfort and resolution to the patient in the end-of-life stages must be giving girding by the support of general nurses who come into contact with the patient in the acute care setting. This is especially the case where, as is frequently true, the primary caregiver is also a member of the family of the deceased. Such cases instigate an array of emotional experiences and needs that are complex and widely variable. As discussed above, it is often true that the passing of a loved one who has experienced a protracted illness, who has suffered at length and who has imposed a practical burden on the family will create a sense of relief. This is a natural human experience in which the individual's state of illness has suspended or extended the grieving process, whereas death allows for ultimate confrontation of grief and the beginning of a process of moving on.

Still, for those family members whose lives have come to revolve around the provision of care for this loved…