Patients' and nurses' constructions of death and dying in a hospice setting

This paper reports on an aspect of the findings derived from a qualitative study and provides a prospective account of a defined period in the lives of 12 individuals dying in a hospice. The primary focus is on the patients' construction and management of their experiences in confronting impending death, and on their nurses' experiences in caring for these individuals as they died.

The theoretical basis of the study was drawn mainly from a symbolic-interactionist perspective, within an interpretive interactionist framework. Unstructured interviews and participant observation were used as the primary methods of collecting data. Data from interviews were subsequently collated and coded, and comparative analyses between cases were performed.

The detailed case study material provides insight into how patients and their nurses construct and manage their experiences in confronting impending death. For example, in interviews with patients whose death was imminent, and with their nurses, reference was often made to the ‘body’ as separate from the ‘self’. In particular, the nurses' constructions of a ‘body-person split’ were made by direct reference to the body as a separate entity from the personal self, in attempts to gauge the patient's ‘readiness to die’. This ‘readiness to die’ conceptual map appeared to be characterized by the following four modes: person ready, body not ready; person ready, body ready; person not ready, body ready; and person not ready, body not ready.

These ‘body-person split’ and ‘readiness to die’ constructions provide an additional dimension to current theoretical conceptualizations about the dying process. Although theories on death and dying have previously focused on elements such as individuals' reactions, awareness, and time and duration of dying, the notion of separating body and self as a paradigm for understanding the manner and readiness of dying has not been raised and clearly requires further research. Thus, the fresh empirical material from the present study necessitates modification of current theories of dying and death.