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Making sense of life close to death
Örebro University, School of Health and Medical Sciences. (Vårdvetenskap, Omsorg vid livets slut och andra kritiska händelser)
Enheten för forskning om vård i livets slutskede, Ersta, Stockholm, Sverige. (vårdvetenskap, omsorg vid livets slut och andra kritiska livshändelser)
Örebro University, School of Health and Medical Sciences. (Vårdvetenskap)
Örebro University, School of Health and Medical Sciences. (Vårdvetenskap)
(English)Manuscript (preprint) (Other academic)
Abstract [en]

This study’s aim was to find out how dying patients experience living near impending death. Eleven patient interviews were conducted via a palliative care unit that included a hospice ward and palliative home care. A qualitative, inductive design enabled descriptions of this complex situation. Analysis followed the Thorne et al. interpretive description approach. The findings revealed that when death became a reality, life took on new meanings and values (not in clear focus before) that were important to preserve or protect. This triggered need for feeling secure within this situation. These revelations were manifest in three subthemes that conceptualised the main theme Making sense of life close to death: (1) when possible death becomes a reality; (2) living with death as a reality and (3) a need for a feeling of security. How life can seem to dying patients demonstrates clinical relevance and complexity, which ensues when death is understood. Nurses must be aware of and respond to that complexity. Responding to patients who protect themselves from existential insight is a particular challenge; preserving their dignity requires being open to how life appears to them and following them as they give meaning to their existence. Dying patients have the right to be cared for according to their understanding of what it means to be dying.

Keywords [en]
dying, interviews, lived experience, palliative care, patients, qualitative
National Category
Nursing
Research subject
Nursing Research w. Social Science Orientation
Identifiers
URN: urn:nbn:se:oru:diva-5432OAI: oai:DiVA.org:oru-5432DiVA, id: diva2:159687
Available from: 2009-02-09 Created: 2009-02-09 Last updated: 2017-10-18Bibliographically approved
In thesis
1. Att leva nära döden: patienters och vårdpersonals erfarenheter inom hospicevård
Open this publication in new window or tab >>Att leva nära döden: patienters och vårdpersonals erfarenheter inom hospicevård
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This research focused on experiences of dying patients and hospice nurses in a hospice unit. The research objectives were to (i) acquire more extensive knowledge about how dying patients and hospice nurses experience life and death and (ii) describe patients who were cared for during a 10-year period in an inpatient hospice ward. Data were gathered via interviews with 19 nurses and 11 patients. An interpretive description method was used to analyze interview results. Data were also gathered from institutional care records that included gender, age, marital status, diagnosis, referral source, and length of stay (666 women and 555 men). Descriptive statistics were used to describe basic features of the study's data and to compare differences between women and men. The main finding from interviewing the nurses was that they were struggling to acknowledge and unveil the person within the weakening body. In doing so, they used various strategies such as (i) striving to understand patients’ experiences of body function loss; (ii) encouraging patients to uphold body functions and daily habits; (iii) acknowledging and balancing patients’ need for body control; and (iv) providing tender care for the body. After 2 years of work in hospice care, nurses described that facing the dying and death of many patients had an impact on daily work and private life. The close relationship with the dying patient led to existential issues concerning the meaning of life and death, which were conceptualized into this theme: death as an agent of change. Eleven years later, the presence of death took a less dominant place in the nurses’ lives, and the theme became: death as a companion in life. In the long-term, nurses emphasized that their relationships with dying patients fostered their professional and personal growth. The findings from interviewing the patients revealed that when death became a reality, life took on new meaning, and they acquired new values that were important to preserve or protect; this triggered need for feeling secure within this situation. These revelations were manifest in three sub-themes: (i) when possible death becomes a reality; (ii) living with death as a reality, and (iii) a need for a feeling of security. And this main theme was conceptualized: making sense of life close to death. Results regarding patients in hospice ward care over a 10-year period revealed significant differences between women and men. More women than men were single, had cancer with relatively short trajectories, and were referred from the oncology department. More men than women were diagnosed with types of cancer with somewhat longer trajectories. Despite longer trajectories, length of stay was shorter for men than for women. The most frequent referral source was the hospital. But compared to women, men (particularly younger men) were more often referred from home-based hospice care. The findings expand knowledge about dying and its various configurations; consequently, care and support needs will vary. For the dying person, it is important to know that care is provided according to the person’s preferences and given when needed.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2009. p. 97
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 23
Keywords
death; dying; hospice care; hospice nurse; palliative care; patients; patient characteristics
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-5439 (URN)978-91-7668-650-8 (ISBN)
Public defence
2009-03-06, Hörsal P2, Örebro universitet, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-03-30 Created: 2009-02-09 Last updated: 2017-10-18Bibliographically approved

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Källström Karlsson, Inga-LillEhnfors, MargaretaSunvisson, Helena

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CiteExportLink to record
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Citation style
  • apa
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