Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Jane M. Georges, PhD, RN, Chair; Mary Rose Mueller, PhD, RN; Maryanne Garon, DNSc, RN


decision-making, health-related behaviors, near-death experience, nursing


While broad categories of health and influences on definitions of health have been identified, the process through which adults define and re-define health has not been researched. The purpose of this study was to investigate the process of defining health and appropriate health-related behaviors following a near-death experience (NDE) as an adult and to articulate a grounded theory of decision-making. Five men and 15 women from the United States and United Kingdom were interviewed and the data were analyzed using the constant comparative method. The basic social process was I Still Had to Go Through the Process of Understanding. Understanding involved making sense of the NDE and precipitating event, gaining knowledge and insight, and applying this information in everyday life. This process was comprised of coming back, defining health, the experience of health, and meaning. The latter was a thread which ran through the entire process and was related to both the near-death experience and living one's health. Coming back involved coming to terms with the physical, emotional, and spiritual consequences of the event, understanding what the NDE was and what it meant, and achieving some level of stabilized health. When their health was stable, participants were able to think about what health was and how it could be achieved or maintained. This typically occurred in three trajectories: the immediate aftermath, a combination of intervals, and over time. Imagery seen or meanings given to the NDE often influenced definitions of health and health behaviors. The experience of health included thinking about health, living with health issues, and exposure to external sources of health information. Self-management and living well described the two broad philosophies and strategies used to live health. These findings extend existing views of health, support research identifying multiple definitions of health and patterns of health behaviors, support the need to ask clients about health beliefs and health practices, and have implications for nursing practice, research, and education.

Document Type

Dissertation: Open Access



Included in

Nursing Commons