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Health Challenges of Family Members in End of Life Situations
Title
Health Challenges of Family Members in End of Life Situations.
Creator
Sopcheck, Janet, Liehr, Patricia, Florida Atlantic University, Christine E. Lynn College of Nursing
Abstract/Description
The growing older adult population, their age-related morbidities, and lifelimiting chronic illnesses increase the demand for quality yet cost-effective end of life (EOL) care. Losing a loved one creates emotional turmoil, heightened uneasiness, and EOL uncertainties for family members. Understanding the complex needs of family members and supportive actions deemed most significant to them can guide nurses to enhance EOL care, encouraging palliation and peaceful death experiences. This study...
Show moreThe growing older adult population, their age-related morbidities, and lifelimiting chronic illnesses increase the demand for quality yet cost-effective end of life (EOL) care. Losing a loved one creates emotional turmoil, heightened uneasiness, and EOL uncertainties for family members. Understanding the complex needs of family members and supportive actions deemed most significant to them can guide nurses to enhance EOL care, encouraging palliation and peaceful death experiences. This study used a qualitative descriptive exploratory design guided by story theory methodology to explore the dimensions of the health challenge of losing a loved one who had been in an acute care setting during the last three months of life, the approaches used to resolve this health challenge, and turning points that prompted decisions about a loved one’s care with 15 older adults residing in a Continuing Care Retirement Community (CCRC) in Southeast Florida. Theoretical grounding for this study was Watson’s (1988, 2002) theory of human caring and Smith and Liehr’s (2014) story theory. Older adults’ stories were analyzed through theory-guided content analysis. Themes that describe the health challenge 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. Approaches to resolve this challenge include 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. Failure to establish normalcy, coming to grips with abrupt health decline/demise, and recognition – there’s nothing more to do – were the turning points identified by CCRC residents. Older adults’ vivid recollections of losing a loved one and willingness to share EOL concerns as well as recommendations regarding support of family members who are facing this challenge serve as invaluable guidance for improving EOL care for dying patients and their family members.
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Date Issued
2016
PURL
http://purl.flvc.org/fau/fd/FA00004635
Subject Headings
End-of-life care., Terminal care--Psychological aspects., Hospice care., Palliative treatment., Critical care nursing., Loss (Psychology)
Format
Document (PDF)
Iranian American Older Adults’ Attitudes and Proactive Actions Toward Planning Ahead for End-of-Life Care
Title
Iranian American Older Adults’ Attitudes and Proactive Actions Toward Planning Ahead for End-of-Life Care.
Creator
Rahemi, Zahra, Dunphy, Lynne M., Florida Atlantic University, Christine E. Lynn College of Nursing
Abstract/Description
Ethnically diverse older adults are the fastest growing population in the U.S. This population may experience transitional processes associated with immigration, acculturation, aging, and end of life (EOL). Advances in technology lead to increases in care options, which can cause uncertainty to make decisions for EOL. Unmade decisions about care prior to becoming unable to communicate are associated with burdens of last-minute decisions at EOL, unwanted intensive EOL treatments for people who...
Show moreEthnically diverse older adults are the fastest growing population in the U.S. This population may experience transitional processes associated with immigration, acculturation, aging, and end of life (EOL). Advances in technology lead to increases in care options, which can cause uncertainty to make decisions for EOL. Unmade decisions about care prior to becoming unable to communicate are associated with burdens of last-minute decisions at EOL, unwanted intensive EOL treatments for people who may die naturally of old age, financial and emotional costs, and decreased quality of life. In the U.S., a multicultural country with a variety of care options, advance directive (AD) completion and advance care planning (ACP) may improve culturally competent and person-centered care at EOL. However, the rate of AD completion and ACP is low among Americans, especially immigrant communities. These communities, including Iranian-American older adults, have been frequently understudied, and there is a gap in studies of EOL desires, attitudes, and actions/behaviors. This inquiry focused on planning ahead for EOL care across transitional processes that older immigrants may face. The aim was to enhance culturally competent care for older adults through distinguishing significant factors, which may influence planning for EOL care. Specific purposes were: To identify relationships between attitudes toward planning for EOL care and social supports, spirituality, healthcare system distrust, and acculturation; to identify a relationship between attitudes and proactive actions toward planning ahead in Iranian-American older adults. Conceptual frameworks for this descriptive, cross-sectional study included Culture Care Diversity and Universality and Transitions theories. Findings from 135 participants revealed that they were new immigrants to the U.S. (mean year of 23 in the U.S., 97% born in Iran) and highly educated and insured with high health statuses. About 55% preferred non-intensive treatments and/or homecare at EOL, and 52.6% had not communicated their EOL wishes. Attitudes toward planning ahead for EOL were positively associated with acculturation and healthcare system distrust, and negatively associated with spirituality. No significant association was found between attitudes and social support. Furthermore, favorable attitudes predicted higher proactive actions to communicate wishes. Implications for practice, policy, education, and recommendations for further studies were discussed.
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Date Issued
2017
PURL
http://purl.flvc.org/fau/fd/FA00004939
Subject Headings
Older people--Long-term care., Advance directives (Medical care), Health planning--United States., Right to die., Life care planning., Terminal care--Moral and ethical aspects., Immigrants--Psychology.
Format
Document (PDF)
Thai nurses' lived experience of caring for persons who had a peaceful death in intensive care units
Title
Thai nurses' lived experience of caring for persons who had a peaceful death in intensive care units.
Creator
Kongsuwan, Waraporn., Christine E. Lynn College of Nursing
Abstract/Description
The objective of this study was to describe the lived experience of caring for persons who had a peaceful death in the intensive care units in Thailand. A qualitative research design informed by hermeneutic phenomenology was used to analyze data. Participants were 10 intensive care nurses working at adult intensive care units in south Thailand. A snowball purposive sampling method was used to select the participants. Participant inclusion criteria were at least six months' critical care...
Show moreThe objective of this study was to describe the lived experience of caring for persons who had a peaceful death in the intensive care units in Thailand. A qualitative research design informed by hermeneutic phenomenology was used to analyze data. Participants were 10 intensive care nurses working at adult intensive care units in south Thailand. A snowball purposive sampling method was used to select the participants. Participant inclusion criteria were at least six months' critical care nursing experience, experience in caring for a person who had peaceful death, able to describe peaceful death, and willing to participate in this study. Participants who met the inclusion criteria were interviewed. Face-to-face individual verbal interviews were conducted in the Thai language. These interviews were audiotape recorded. Descriptions were transcribed and translated for data analysis. Van Manen's (1990) hermeneutic phenomenological approach was used to analyze and interpret the data. The findings of this study were presented in each of 4 categories of the lived world of temporality, of spatiality, of corporeality, and of relationality. The description of the lived experience of caring for persons who had a peaceful death in ICU was, "understanding the other through the valuing of experience and enhancing relations with others by recognizing time is short and is a priority." This study may contribute to nursing knowledge of the end-of-life care to enhance a peaceful death in intensive care units congruently with Thai culture and society. In addition, this study directs the translations of its knowledge into implications that will benefit in helping Thai nursing to move forward. The implications of this study in advance will benefit terminally ill persons and family members regarding receiving good quality end-of-life care.
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Date Issued
2009
PURL
http://purl.flvc.org/FAU/186331
Subject Headings
Criticism and interpretation, Intensive care nursing, Nurse and patient, Terminal care, Psychological aspects, Nursing, Practice
Format
Document (PDF)