Confronting Mortality: Narratives of Military Veterans Enrolled in Home Hospice Care.
Confronting Mortality: Narratives of Military Veterans Enrolled in Home Hospice Care.
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面对死亡：参加家庭临终关怀的退伍军人的叙述。
DOI：
10.1097/njh.0000000000000250
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Daly,BarbaraJ
中科院分区：
文献类型：
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作者：
Prince-Paul,Maryjo;Peereboom,Karen;Daly,BarbaraJ
背景：登记参加退伍军人事务部(VA)医疗服务的退伍军人中，近85%死于退伍军人事务部设施外，但人们对他们的死亡情况知之甚少。虽然只有4%的退伍军人死亡实际发生在退伍军人设施内，但我们对退伍军人的临终需求和偏好的了解大多来自退伍军人数据，只反映了一小部分退伍军人在生命末期的经历。目的：本研究的目的是增进对退伍军人在家庭临终关怀中的理解和意义。方法：采用主题分析的解释学定性方法，探讨年龄在56岁至95岁之间的退伍军人的15个叙事的含义和意义。深入的、半结构化的、面对面的采访被录音并逐字转录。使用固有阅读和重读的来回移动使研究团队能够完全沉浸在数据中。在逐行编码后，识别出主题和子主题。结果：有五个主题描述了退伍军人在生命末期的意义，包括有限的机会、破裂的关系、义务、作为一生的影响而不是定义的服兵役、以及对死亡缺乏恐惧/接受。结论：尽管这些发现狭隘地聚焦于家庭临终关怀中的特定人群，但这些发现需要区分“服役中死亡”和“自然过程中死亡”。所有参与者都谈到，作为一名退伍军人并不是他们的核心身份，而是他们认为自己是经历过多种肤色的人。含义：尽管表彰和表彰为国家服务的退伍军人似乎是基本的，但临床医生应该认识到，这种尊重的姿态可以被视为不尊重。对退伍军人生命经历意义的个性化关注可能会让临床医生更充分地了解如何在生命末期照顾退伍军人的需求。
Background:Nearly 85% of veterans who do enroll for Department of Veterans Affairs (VA) health services die outside VA facilities, yet little is known about the circumstances of their deaths. Although only 4% of veteran deaths actually occur within VA facilities, most of what we know about end-of-life needs and preferences of veterans has come from VA data and reflects only a small proportion of veterans’ experiences at the end of life.Objective:The aim of this study was to advance the understanding and meaning of being a military veteran enrolled in home hospice care.Methods:A hermeneutic qualitative approach using thematic analysis was used to explore the meaning and significance of 15 narratives of military veterans between the ages of 56 and 95 years. In-depth, semistructured, face-to-face interviews were audio recorded and transcribed verbatim. A back-and-forth movement using inherent reading and rereading allowed the research team to be fully immersed in the data. After line-by-line coding, themes and subthemes were identified. Criteria for trustworthiness guided verification that the qualitative analysis represented the data.Results:Five themes emerged that described the meaning of being a military veteran at the end of life, including Limited Opportunities, Broken Relationships, Obligation, Military Service as a Life Influence Not Definition, and Lack of Fear/Acceptance of Death.Conclusions:Although narrowly focused on a particular population in home hospice care, these findings warrant distinction between “dying while in service” and “dying through natural process.” All participants spoke about how being a veteran did not serve as their core identity, rather they identified as individuals who have lived many colors.Implications:Although honoring and acknowledging veterans for their service to our country seem fundamental, clinicians should recognize that this gesture of respect can be viewed as disrespect. Individualized attention to veterans’ meanings of life experiences may allow clinicians to more fully understand how to attend to veterans’ needs at the end of life.