The growing older adult population, their age-related morbidities, and lifelimiting chronic illnesses increase the demand for quality yet cost-effective end of life (EOL) care. Losing a loved one creates emotional turmoil, heightened uneasiness, and EOL uncertainties for family members. Understanding the complex needs of family members and supportive actions deemed most significant to them can guide nurses to enhance EOL care, encouraging palliation and peaceful death experiences. This study used a qualitative descriptive exploratory design guided by story theory methodology to explore the dimensions of the health challenge of losing a loved one who had been in an acute care setting during the last three months of life, the approaches used to resolve this health challenge, and turning points that prompted decisions about a loved one’s care with 15 older adults residing in a Continuing Care Retirement Community (CCRC) in Southeast Florida. Theoretical grounding for this study was Watson’s (1988, 2002) theory of human caring and Smith and Liehr’s (2014) story theory. Older adults’ stories were analyzed through theory-guided content analysis. Themes that describe the health challenge include moving from painful holding on to poignant letting go, uneasiness that permeates everyday living and precious memories, patterns of disconnect that breed discontent, and pervasive ambiguity that permeates perspectives about remaining time. Approaches to resolve this challenge include active engagement enabling exceptional care for loved ones, appreciating the rhythmic flow of everyday connecting and separating to get by, and embracing reality as situated in one’s lifelong journey. Failure to establish normalcy, coming to grips with abrupt health decline/demise, and recognition – there’s nothing more to do – were the turning points identified by CCRC residents. Older adults’ vivid recollections of losing a loved one and willingness to share EOL concerns as well as recommendations regarding support of family members who are facing this challenge serve as invaluable guidance for improving EOL care for dying patients and their family members. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

Empowerment for those supporting the bereaved lies in understanding the processes by which meaning is constructed out of a loss. My concern is that models currently underpinning understanding and practice in grief recovery provide limited assistance to loss and grief practioners. These theories, based around set stages and tasks with pre-determined objectives, offer stereotypic "after the event" perspectives on the recovery process. This has value as background information, but in the extreme promotes a clinical, de-personalised approach to uderstanding and support. My experiences over more than a decade of working alongside the suicide-bereaved in particular, suggest that a more enlightened pathway lies with people and their stories. Working in an empathic dialogic relationship, with an emphasis on understanding rather than closure, is more appropriate in assisting those treading the very sensitive, very personal, bereavement path. Furthermore, the narrative grounded approach is more in tune with the processes involved; and more likely to lead to productive outcomes in both the short and long term.The presented model argues that bereavement recovery is a re-educative reconstruction process: trialogic, semiotic sign or symbol related; recognising significant personal autonomous control; genetically or organically activated and driven; dynamic and ongoing; and constructed out of the individual's socio-cultural knowledge base. The model further argues that recovery is best constructed in a climate of empathic understanding and genuine non-judgemental acceptance of the bereaved individual's current perceptual world. In expounding and supporting this model, the tradition of pragmatic educational philosophy has been found useful - in particular, relevant apects of the theories of Carl Rogers, John Dewey, Alfred Shutz and Charles Stanford Peirce.I contend that the proposed model may be applied to all forms of profound loss, however the main context for this research is a Bereaved-by-Suicide Support Group.

Thesis (M.A.)--York University, 2003. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 93-101). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ86319

Thesis (Ph.D.)--Ohio University, August, 2009. / Release of full electronic text on OhioLINK has been delayed until September 1, 2012. Includes bibliographical references (leaves 185-254)

Thesis (Ph.D.)--Ohio University, August, 2009. / Title from PDF t.p. Release of full electronic text on OhioLINK has been delayed until September 1, 2012. Includes bibliographical references (leaves 185-254)

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 101-109). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 101-109). Also available on the Internet.

Thesis (D. Min.)--Northern Baptist Theological Seminary, 2000. / Abstract. Includes bibliographical references (leaves 145-148).

The purpose of this research study was to capture the experience of a multigenerational, resilient family who had experienced a nonnormative stressor event. A phenomenological case-study approach was utilized as methodology to guide this study. Interviews were held collectively with the entire family and individually with participating family members. All interviews were audio-taped and transcribed. The family's story of resilience emerged from this transcript material. In addition, the process of thematic analysis yielded nine main intergenerational themes that helped to explain this family's resilience. They included: 1) Be flexible about communication; 2) Connect with one another; 3) Have access to and accept support; 4) Detach from the experience; 5) Normalize the stressor; 6) Minimize the children's distress; 7) Focus on the positive; 8) Find strength in religion and 9) Find creative ways of coping. Results also indicated a strong multigenerational component to this family's resilience. In addition, resilience was found to be a process made up of both struggle and occasional costs. Findings were compared to relevant professional literature on family resilience, including The Resiliency Model of Family Stress, Adjustment and Adaptation developed by McCubbin, McCubbin, Thompson and Thompson in 1995. All of these findings led to a number of implications for counselling practice, as well as for future research.

The present analogue study compared the effects of 2 theoretically divergent Life Review group psychotherapies on aspects of late life adjustment and development. Thirty-six adult non-patients, ages 65 years and older, from the Muncie - Delaware County vicinity, were randomly selected from an available subject pool of screened volunteer respondents and randomly assigned to one of three analogue treatment conditions with two groups for each treatment condition. These three treatment conditions were the structured reminiscence life review group (SRLR), the Gestalt life review group (GLR) and a Wait List control group (WLC). Demographic, mental status, and Activities of Daily Living Scale (ADL) data were obtained from initial respondents by telephone interview and followed by written completion of the Symptom Checklist (SCL 90-R). The differential effects of treatment were measured by pre and post testing on four dependent variables: (1) depression, (2) congruence, (3) helplessness, and (4) ego integrity.Results indicated that neither of the two life review group psychotherapy treatments had any statistically significant effect upon the dependent variables. In a post hoc exploratory analysis, evidence emerged which suggested that the participants in the GLR treatment condition may have shown significant improvement on several state mental health variables. The dimensions of improvement for participants in the GLR were Interpersonal Sensitivity, Hostility, Depression, and Positive Symptom report as measured by the SCL 90-R. This contrasted with those in both the SRLR or WLC condition for whom no improvement was shown. / Department of Counseling Psychology and Guidance Services