Purpose/objectives: To explore how family care-givers develop and respond to an awareness that their relative is dying.
Design: Qualitative, interpretive.
Settings: Four major providers of cancer services in Brisbane, Australia, including a hospital, hospice, homecare nursing service, and oncologist's office.
Sample: 20 recently bereaved adult family caregivers (mean age = 48.5): 11 females, 9 males--16 spouses, 2 daughters, and 2 mothers of adults.
Methods: Semistructured interviews transcribed verbatim and content analyzed.
Main research variable: Developing and responding to an awareness of dying.
Findings: Five major themes emerged from the analysis. Two core categories, Being Uncertain and Agonizing, depict the emotional struggles that characterize the process of developing an awareness of dying. Three additional categories-Hoping, Pretending, and Preparing-represent strategies used by family caregivers to manage these emotional struggles.
Conclusions: Developing an awareness of dying is a gradual process for family caregivers. Uncertainty and anguish characterize this process. Several factors contribute to this uncertainty and agony, including interactions with healthcare providers. Family caregivers attempt to manage this developing awareness by hoping, pretending, and preparing for death.
Implications for nursing practice: Nurses need to identify processes to ensure that family caregivers' needs for information and support are given high priority and that supportive interventions identified are based on a sensitive understanding of the experience of the family caregiver. The processes may include assisting family caregivers to maintain hope, sustain social relationships, and make preparations for the death. Further research into how family caregivers use these strategies for managing their developing awareness of dying is required.