International Journal of Mental Health Nursing(2003)12,74–85INTRODUCTIONThe act of suicide is as old as the history of human exis-tence on Earth. Suicidal death remains so final for anyone,yet when a teenager or young adult who appears to havethe prime years of their life in front of them, makes thedecision to die by their own hand, it seems even moretragic. For family members left behind, the suffering, thewondering why and the pain of bereavement remain,sometimes for the rest of their lives.As the scope of nursing practice broadens, nurses inmental health, acute care (e.g. intensive care units,accident and emergency centres) and primary health-caresettings are increasingly called on to work with familymembers (survivors) bereaved through the suicide of aloved one.Literature reviewPrior to starting this investigation an initial literaturereview was conducted to identify its currency, relevance tothe New Zealand situation and identify any gaps. Olderstudies comparing reactions of family and friends bereavedby suicide and other sudden deaths, such as accidents andhomicide have been conducted mostly in the USA andEngland (Kovarsky 1989; Range & Niss 1990). While suchcomparison studies have value in identifying differencesbetween predetermined reactions and responses to thedeath of a loved one and bereavement, because they usespecific measurement scales, they are unlikely to revealexperiences that are outside of those predetermined bysuch scales. For this reason they are unlikely to illuminateontological understandings (or retain a focus on the natureand relations of being) of what it means to have a familymember die through suicidal death.Van Dongen (1990, 1991a, 1991b, 1993) used a mixedgrounded theory/quantitative approach to explore thesocial relationships and perceived social support of 35adults whose family members had completed suicide.Findings revealed the core variable agonizing questioning(Van Dongen 1990; p. 225; 1991b; p. 32) with associatedvariables of emotional turmoil, cognitive dissonance (VanDongen 1990; p. 226; 1991b; p. 32) physical disturbancesand survival strategies (Van Dongen 1990; p. 227; 1991b;p. 34).
