Bonus time: A gay man's experience as a long-term HIV survivor.

The time after diagnosis of a terminal illness can be demanding. It requires adjusting to change while trying to maintain some sense of normalcy. The purpose of this qualitative case study was to gain an understanding of how one person lived his life while facing death. During the interview, the researchers used photo elicitation to contextualize events in the participant's life. Thematic analysis identified three main themes: Finding Life's Purpose, Being (In)visible, and Illusion of Control. To better understand the participant's struggles and triumphs as he created a new existence, the researchers applied Parse's Theory of Human Becoming to the study's findings.

Successful Advance Care Planning in a Rural Nursing Home.

BACKGROUND:: Advance care planning (ACP) often culminates in the completion of advance care directives (ACD), which is a written record of informed decisions specifying the type and extent of desired medical treatment. Documentation of ACD in nursing homes in the United States indicates a 60% to 70% completion rate. There are little data on the time at which ACD are completed in relation to when the resident was admitted to the nursing home facility. OBJECTIVE:: To explore the success of advanced care planning at a large, rural long-term care (LTC) facility. METHODS:: A descriptive approach, using a retrospective chart review, of 167 residents was used to examine resident completion of health-care system documents, legal documents, predisposing factors (resident demographics and psychosocial characteristics), and the actual process of ACP as defined by the rural LTC facility. RESULTS:: This nursing home utilizes a document entitled resident preference for life-sustaining treatment (RPLST). For residents who do not have formal prepared advance directive documents, the RPLST serves to define resident and family choices for resuscitation and implementation of fluids, nutrition, medications, and antibiotics. The most striking finding was the completion rate of the RPLST within 100 days of being admitted to the nursing home. CONCLUSION:: Documentation of end-of-life preferences within 10 days of admission was achieved through the incorporation of RPLST during the resident admission process.

Nursing students' perceptions of faculty trustworthiness: Thematic analysis of a longitudinal study.

BACKGROUND: Although trust and perceived trustworthiness have been studied for decades, few studies have examined nursing students' perceptions of faculty trustworthiness. OBJECTIVES: To uncover the characteristics and behaviors of faculty members that lead nursing students to trust them. DESIGN: A longitudinal, qualitative study using focus group data. SETTING: A baccalaureate nursing school at a state university in the southeastern United States. PARTICIPANTS: Two cohorts of nursing students (starting in the Fall of 2015 or Spring of 2016) during the beginning, middle, and end of their advancement through the nursing school curriculum. METHODS: Eleven focus groups were held with a total of 77 participants from a purposeful sample of two cohorts. Thematic analysis was conducted on the focus group data. RESULTS: Three core themes emerged regarding the characteristics and behaviors of faculty members that lead nursing students to trust them: Giving of Oneself, Being Competent, and Having Integrity. The study findings provide guidance to nursing faculty regarding how to be perceived as trustworthy by students and how to avoid being perceived as untrustworthy. CONCLUSIONS: Upon examining their personal traits, words and behaviors, nursing educators may choose to change aspects of their demeanor to foster a student-faculty relationship built on trust.

Opening Life's Gifts: Facing Death for a Second Time.

Prior to the development of effective antiretroviral therapy, persons diagnosed with HIV thought they were going to die. Now, long-term survivors are contemplating death again as they age and develop other chronic diseases. The purpose of our study was to understand the experiences of adults living with HIV for 20 or more years as they faced death for a second time. Hermeneutic phenomenology guided the research as participants shared their lived experience through storytelling. Each person's story was audiotaped and transcribed verbatim. Transcript analysis occurred as data were collected. Three common themes from the narratives were identified: Making Choices, Transformation of Fear, and Meaning of Death. Positive and negative pathways influenced each participants' decision-making. Over time, fear of dying was transformed and energy was directed toward living. Even though the participants in this study were facing death again, they recognized it as a natural part of life.

A good death.

BACKGROUND: On a day to day basis, nurses are facing more ethical dilemmas during end-of-life care resulting in not being able to actualize a good death for patients. RESEARCH OBJECTIVE: The purpose of this study was to explore how experienced hospice nurses resolve day to day ethical dilemmas during end-of-life care. RESEARCH DESIGN: The study used a qualitative narrative approach. PARTICIPANTS: Through purposeful sampling, a total of six experienced hospice nurse participated. Ethical considerations: Approval from the researcher's university Institutional Review Board for ethical review was obtained. FINDINGS: Using core story creation, several different ethical dilemmas were identified divulging struggles with key stakeholders including family members and providers. Thematic analysis generated three main themes: Ethics within Practice, Ethical Knowledge, and Ethical Solutions. DISCUSSION: The participants told their stories depicting a keen awareness of ethical conflicts situated by contextual factors including social, political, and personal issues. The nurses' deliberations were informed through formal, experiential, and intuitive knowledge. Ethical predicaments were resolved by either following rules or choosing acts of resistance. CONCLUSION: A better understanding was obtained on how experienced hospice nurses successfully resolve ethical dilemmas culminating in better deaths for patients.

Perceptions and experiences of nursing students enrolled in a palliative and end-of-life nursing elective: A qualitative study.

BACKGROUND: The Carnegie Foundation has identified three professional apprenticeships in nursing that are key to helping students acquire a professional identity. These apprenticeships integrate knowledge acquisition (cognitive apprenticeship), practical experience (practical apprenticeship), and an ethical identity (ethical comportment) for guiding conduct. To ensure that patients have a good death, it is important that faculty incorporate diverse teaching strategies from all three apprenticeships into palliative and end-of life nursing education. OBJECTIVE: The purpose of this study was to examine perceptions and experiences of nursing students enrolled in a palliative and end-of-life nursing elective that was developed and implemented using the three professional apprenticeships. DESIGN: A qualitative research design was used to obtain data from students who completed the palliative and end-of-life nursing elective. SETTING: The study was implemented at a state supported baccalaureate nursing program located in the south eastern United States. PARTICIPANTS: A purposive sample of 19 students who had completed the palliative and end-of-life nursing elective was included in the study. METHODS: After completing the course, focus groups were conducted with the student participants. Discussion was guided by questions to elicit which experiences were most helpful to student learning. Thematic analysis of the data was conducted by three researchers. FINDINGS: Three themes reflecting the apprenticeships were identified: learning from stories, learning from being there, and learning from caring. Students' understandings about end-of-life care were enhanced by incorporating teaching strategies addressing the apprenticeships. CONCLUSION: In end-of-life nursing education, teaching strategies must provide meaningful connections between the student, course content, practical experience, and the dying patient.

Integrating professional apprentices into an end-of-life course.

Nursing education faces several challenges in providing quality and meaningful education. Providing such an education is most important in teaching end-of-life care, as nurses are pivotal in helping patients to achieve a good death. A good death is often based on physical comfort, preparation for death, and completion of social and emotional tasks. Many obstacles hinder a patient's wishes about dying, including how nurses perceive their role in end-of-life care situations and knowing how to intervene on behalf of the patient. Therefore, nursing education needs to create meaningful and relevant learning experiences to enable future nurses to effectively care for the dying patient. To this endeavor, the Palliative and End-of-Life Care course described in this article integrated knowledge through the use of three professional apprenticeships: (a) acquiring and using knowledge and science (cognitive), (b) using clinical reasoning and skilled know-how (practice), and (c) ethical comportment and formation (moral reasoning).