Date of Award


Degree Name

Doctor of Nursing Science

Dissertation Committee

Mary P. Quayhagen, RN, DNSc, Chairperson; Patricia A. Roth, RN, EdD; Kathleen M. Burns, RN, EdD


adaptation, death & dying, nursing, Physiological psychology


The purpose of this study was to examine the interrelationships of the person-environment variables of age, sex, length of illness, pain, social support, and physical function as they affected psychological adaptation in dying. An adaptation paradigm of constructs from nursing, illness, and dying provided the theoretical framework which was used to formulate and test a causal model. This study, in addition, had a qualitative component that identified, from the participants' spontaneous responses, reactions to and perceptions of the dying process. A sample of 97 adults was recruited from two metropolitan home hospice programs, with testing occurring in the home. Regression techniques were used to test the causal relationships. The predictor variables accounted for 38% of the adjusted variance in psychological adaptation. Analysis confirmed the significance of the variables of social support, pain, and age as direct predictors of the outcome. The grounded theory method was used to record, code, and analyze the subjects' responses. The central construct that emerged was hierarchical process patterns of self-transactions which represented higher and lower levels of death awareness. These patterns were: transcending; becoming; reconciling; anguishing; avoiding; relinquishing; and regressing. The core concepts contained within self-transactions were the "integrating forces" of the person and environment influences, and the "moving template" of the dialectical motion within dying. The dying persons in the higher patterns interpreted meaning, connected with others, accepted and adjusted expectations, and managed symptoms. In the lower patterns, the dying persons agonized in suffering, and avoided or repressed cognitions. The themes of spirituality, hope, personal control, acceptance, time, boredom, coldness, and asthenia emanated from the data. The subjective responses validated the quantitative findings in the study.

Document Type

Dissertation: Open Access



Included in

Nursing Commons