Being-With Dying: Tacit Wisdom Embedded in the Experiences of Nurses Who Attend to Dying
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Dying persons and their family members have needs that are notably unidentified and unmet in the United States today. This is in large part due to health professionals' being unprepared to provide end of life care that assists persons in their transition from dying to death with personal dignity and peace. Martin Heidegger's existential, interpretive phenomenology informed this study, providing the philosophical background, structures, language and metaphors to interpret narratives for patterns of being-with dying. Semi-structured interviews elicited tacit knowledge embedded in the experiences of nurses who attend to dying, and showed how they comport themselves toward patients, families and others. How the nurses' patterns of being-with helped persons transition peacefully from dying to death is also described in the findings. The patterns were: (a) accepting death is a condition of authentic being-toward death, (b) personal experiences with death and dying enable nurses to connect-with, engage, and attune to patients, (c) possessing an optimum state of mind that is clear, calm, open, unknowing and knowing is a condition of authentic being-toward-death, (d) being-with intervenes, calling forth what another knows, and (e) being-with intervenes, situating and regulating interpersonal space. The patterns are holistic, woven together, and emerge in a presence of authentic being-with dying. They are explicated in a five-point framework and a pyramid for attaining authentic acceptance of death, both of which parallel Heidegger's structures of authentic being-toward-death. This research could extend to include other providers and settings, viz. physicians and to develop more complete frameworks to understand and intervene in the cognitive and affective mechanisms of being with dying, especially those which help and hinder effective being-with dying.
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