Acceptance Process Model of Patients’ Life with Terminally Ill in Home Hospice and Development of a Narrative Approach for Nurses

The prime aim of this study was to find a psychological process model of patients with terminally ill in home hospice investigating the contents of a narrative, and the secondary aim was to create a narrative approach program for nurses. Ten patients narrated their thinking or feelings along with some prepared questions in two sessions. Patients’ narrative data were categorized by a qualitative analysis and 34 categories were chosen. They perceived good points in home hospice like “Being able to spend time freely”, “Close relationships with care staffs and strong confidence”, though they perceived trouble points like “Suffering from putting burden on the people around me” or “Worries about economic problems”. They perceived psychological changes through illness like “Having peace of mind and becoming kind” “Desire for a natural death”. Moreover they perceived their life like “Acceptance of one’s life including illness” “My life lived with satisfaction”. They regarded as important things such as “Spending life time usefully” “Feelings of my family members and of those around me”, and as hopes “Hope to leave my living proof” “Living left time to the fullest”. From these categories, we propose an acceptance model of patients’ life and a narrative program for nurses.

Contents of Care and Perception of Home Hospice Nurses Who Work at Visiting Medical Treatment Hospitals

Goal: The aim of this study was to examine the perception of nurses who worked at the clinic which proposed home hospice and contents of care to better understand home hospice and enhance home care. Methods: Six nurses who worked at the clinic where proposed visiting medical treatment participated voluntarily. They received one interview for approximately one hour, in which they narrated their perception of home hospice and content of nursing care. The narrative was recorded by an IC recorder and analyzed as contents analysis. This study was approved by the Ethical Board at St. Mary’s College. Results: About the content of nursing care, some categories were selected such as “Understanding a patient as a living person,” “Examining if a patient and caregiver live at ease,” or “Caring for a caregiver accepting a loved one’s death and care given at death.” Nurses perceived the theme as “Time and space for listening carefully,” the theme as “Feeling of responsibility and attractiveness of work,” the theme as the “Economics and manpower to continue home hospice,” the as a “Required connection between hospitals and home hospice clinics.” Conclusion: Visiting medical treatment nurses understand a patient and a family as living people based on intimate relationships, support them as the disease progresses, and connect to a visiting nurse station. They perceived that “patients can enjoy freedom;the nurses had responsibility and strong relationships. They felt the economic or man-power needs to continue and the requirement of a connection between hospitals and home hospice clinics.

Perception of Reasons of Decision Making for Home Hospice, Benefits and Difficulties in Home Hospice Care by Family Caregivers

Objective: Home hospice is one of the most important places to spend time at the end of life. It is necessary to clarify the perception of home hospice for family caregivers in order to choose home hospice. The aim of the study was to examine the perceptions of family caregivers about the reasons of decision making for home hospice care, benefits, difficulties with home hospice, and copings. Methods: Ten family caregivers who were taking care of a patient with a terminal illness at home at the time of the study participated voluntary. They participated in two interviews in the narrative approach. In the first session, they narrated reasons of decision making for home hospice, benefits, difficulties, and copings. In the second session, they narrated importance or growth in self. We analyzed narratives in the first session using qualitative analysis. This study was approved by the Ethical Board at St. Mary’s College. Results: Categories of the reasons for the decision making to undergo home hospice were “Being natural to take care of a loved one at home” or “Home hospice matching a family caregiver’s life”. Categories of benefits at home hospice were “To strengthen family’s ties” or “Both a loved one and a family spending time together”. Categories of difficulties were “Difficulty of economic problems” or “Difficulties of mental and physical symptoms”. Conclusion: We concluded that family caregivers perceived benefits and difficulties, and they could cope with difficulties, though spiritual pain remained. We need continuous support for family caregivers at home hospice.