THE " DINNERHOUR" AND OTHER LOSSES: CARING FOR A HOSPICE PATIENT WHO CEASED NUTRITION (DEHYDRATION, ANORETIC, CACHECTIC).
Contributors: Boston College.
Published: 1995
Number of pages: 219
Subjects: Health Sciences, Nursing.; Health Sciences, Nutrition.
Description: The aim of this phenomenologic inquiry was to explore the meaning of nutrition cessation in adult in-home hospice patients with cancer as described by women primary caregivers during the bereavement period.

The literature revealed that two thirds of terminal cancer patients are anoretic/cachectic at death. Reports on nurse, physician and patient perceptions regarding intake cessation had been published. Specific inquiry into the perceptions and meaning of this experience to primary caregivers had not been reported.

Stories were obtained through semi-structured interviews with twelve women who lived the experience. A verbatim written transcript of each interview was studied line-by-line to identify themes and essences (Van Manen, 1990). Shared themes emerged through ongoing comparison across narratives.

The experience represented a major life transition. Seven essential themes, distinct but overlapping realities, emerged from the data: the meaning of food, the caregiver as sustainer, concurrent losses, personal responses, ceasing to be, the meaning during bereavement and paradox.

The meaning of food was discovered to be symbolic, socialized, and deeper than just a resource for physical life. The caregiver as vigilant sustainer attempted to maintain patient normalcy despite progressive decline. Patient changes, types of knowledge needed for caregiving and approaches for encouraging intake were described. A balance between concern and respect directed caregiver choice of action. Concurrent losses, mutually influenced responses and paradox accompanied the transition. Death marked the end of both the patient's physical life and the caregiver role. A dialectic of prior expectations and the reality as it unfolded comprised the meaning for these women during bereavement.

Caregivers believed that intake cessation was not physically painful for these patients. Findings were organized using Roy's (1994) four-component model of the person, and compared to Roy's (1988) Integrated Metaparadigm of Nursing Science. In practice, caregiver's perceptions of patient intake cessation should be opened to dialogue. Anticipatory guidance should be offered with sensitivity to individual meanings. Future investigations should further explore caregiver's and patient's perceptions.
Notes: Source: Dissertation Abstracts International, Volume: 56-10, Section: B, page: 5420.

Thesis (PH.D.)--BOSTON COLLEGE, 1995.

School code: 0016.