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Posts from the ‘Journal Information’ Category

Intermodernism and Nursing Theory Development


The current featured article in ANS 42:1 is by Pamela G. Reed, PhD, RN, FAAN title “Intermodernism: A Philosophical Perspective for Development of Scientific Nursing Theory.” This article will also serve as a focus of discussion at a conference that will convene at Case Western Reserve University March 21-22 in Cleveland, OH, celebrating the 50th year since the first conferences focused on the disciplinary perspective of nursing, and the structure of nursing knowledge. Dr. Reed’s article will serve as a focus for discussion and debate for years to come, prompting advances in nursing knowledge development in the years ahead.  Her aritcle is available to download at no cost while it is featured, and we welcome your comments here!  Dr. Reed sent this message about her work.

Pamela Reed

I am SO pleased to have this paper published in Advances in Nursing Science! It was in this same journal where in 1995 I published a treatise that introduced some initial ideas about a philosophy of nursing science, which I then labeled neomodernism.  This current paper is the outcome of my continued work (and passion) in philosophy of science as it relates to knowledge and theory development in our discipline. In developing this philosophical perspective, I was particularly interested in bringing together the foundational focuses of nursing knowledge with the creative and scholarly ways that nurses practice their profession and science. I drew from philosophical worldviews within and outside of nursing, and from philosophies of science more formally.

I also thought it important to provide (for readers and me!)  some historical perspective on philosophies of science and theory structure, as background for a philosophical view I am  proposing for nursing’s present and future.  Whereas I initially called this view neomodernism, I came to the decision that intermodernism better represented the post-postmodern philosophy that it is – one that incorporates both modern and postmodern ideas. I wanted to articulate a philosophical view that is meaningful to nursing and is also pluralist yet internally consistent.  Accomplishing all of this will likely involve continued work and dialogue!  In the meantime, I hope it can be useful among nursing students as they hone their research questions, and among nursing scholars and maybe also other health science scholars as they formulate new directions for research and practice.

Mostly I am hoping that this article generates discussion among nurses about the role of theory in building nursing knowledge – about new strategies for theory development that integrate practice and science more deliberately, and about expanding perspectives of our familiar ‘nursing theory’ to make it the central cog in the wheel of nursing inquiry into processes or mechanisms underlying human health and well-being.

 

Remembering Margaret Newman


On December 18, 2018, Margaret Ann Newman, prolific nurse author, teacher and theorist, passed over to the great beyond. Margaret authored several notable articles in ANS, was frequently cited in ANS and other journals, and she was a dedicated supporter of ANS since the founding of the journal. Her writings expanded the nursology horizon over the past 40 years with her thought-provoking work. She advanced the knowledge of the discipline of nursing, and has been a key figure in the development of nursing theory.

Margaret was born on born on October 10, 1933 in Memphis. She received a BA degree from Baylor University. After college she returned to Memphis to care for her mother, who had Amyotrophic Lateral Sclerosis (Lou Gerig’s disease). Having learned from her mother that one can be healthy even in the face of disease, Margaret felt a call to nursing and entered nursing school at the University of Tennessee College of Nursing. After receiving her baccalaureate nursing degree, she entered graduate nursing studies at the University of California, San Francisco and received her master’s degree in 1964.

Margaret returned to Memphis and served as UT Assistant Professor of Nursing and the UT Clinical Research Center Director of Nursing. Margaret spent the next 10 years at New York University—first in doctoral studies, receiving her PhD in 1971, and then as faculty. Dr. Newman assumed the position of Professor in charge of Graduate Studies in Nursing at Penn State in 1977, at which time she also organized an international nursing theory think tank. She introduced her theory of health as expanding consciousness in 1978 and published the earliest primer on developing nursing theory: Theory Development in Nursing (1979). In 1984, she assumed a position as nurse theorist and professor at the University of Minnesota, where she furthered the development and testing of her theory, working closely with doctoral students. In the 1980s, she served as a civilian consultant to the U.S. Surgeon General for Nursing Research. Dr. Newman retired from teaching in 1999, yet remained active for another 17 years advancing nursing theory, education, research, and practice through her presentations and publications, including her 7th book, Transforming Presence: the Difference that Nursing Makes (2008). Dr. Newman’s theory of health has been widely embraced around the world and her life will be commemorated in many countries.

For more information, visit these important resources

Nursology.net resources:

A Tribute to Margaret Ann Newman by Margaret Pharris
Health as Expanding Consciousness (HEC) Theory Page
Go to 2016 Newman Scholars Dialogue Page

Memphis Funeral Home obituary

In lieu of flowers, contributions can be made to the fund for the Margaret Newman Endowed Chair

ANS Peer Review Mentoring Program


I am delighted to announce the launch of a peer review mentoring program for early-career scholars in nursing! The ANS Advisory Board has approved this plan in the interest of promoting the entry of new peer reviewers for scholarly publication in nursing, and to more fully enact our dedication to diversity and inclusion in the publishing process. We are encouraging current members of the review panel to participate in this process.  If you are an early-career scholar who is not yet involved in serving as a peer reviewer, let us know you would like to participate in this program and we will facilitate locating a mentor for you!  The full description of the program is available for download here.

To qualify as a mentee for this program, you need to meet the following criteria:

  • Completion of an earned doctoral degree, or in your candidacy anticipating final completion of the degree within the next 6 to 12 months;
  • At least one original published work as primary author that contributes to the development and application of nursing knowledge;
  • Expressed commitment to continued research, theory development, and other activities contributing to the development and application of nursing knowledge;
  • Willingness to complete reviews within approximately 3 weeks of being invited;
  • Ability and willingness to use the ANS Editorial Manager Peer Review Website;
  • Willingness to fulfill the responsibilities of the editorial review panel on a volunteer basis. (adapted from policies for serving on the ANS peer review panel)

Participating as a peer reviewer for scholarly publications is not merely a volunteer service — it is crucial to assure the credibility of published scholarship in any discipline. The main reason that this function must be voluntary is to avoid any possible appearance of conflict of interest, or vested interests influencing or controlling what appears in the literature of the discipline.  However, subtle bias can creep in to the peer review process, especially when reviewers tend to hold dominant points of view that might exclude less well known or accepted perspectives in the nursing literature.  So through this mentoring program, we hope to engage early-career scholars who have demonstrated excellence in scholarship while at the same time bringing to their work diverse perspectives that will be increasingly vital to the future of nursing.

Let us know you want to participate!

 

Featured topics coming up!


Here at ANS, we now publish “general topic” articles in most issues of the journal. These articles are consistent with the general purposes of the journal but not focused on a planned focus. But we still seek manuscripts for “featured topics” that continue our tradition of “calling forth” content that might not otherwise be addressed. Here is the plan for featured topics for the next 18 months, and a reminder of what we mean by “general topic” submissions:

General Topic Manuscripts are welcome any time ​

Manuscripts generally relevant to the purposes of the journal are welcome at any time. The purposes of ANS are to advance the development of nursing knowledge and to promote the integration of nursing philosophies, theories and research with practice. We expect high scholarly merit and encourage innovative, cutting edge ideas that challenge prior assumptions and that present new, intellectually challenging perspectives. We seek works that speak to global sustainability and that take an intersectional approach, recognizing class, color, sexual and gender identity, and other dimensions of human experience related to health.​​

Featured topics
Critique and Innovation
Vol 42:3 –  September 2019
Manuscript due date: January 15, 2019
Consistent with the journal’s tradition, we encourage nursing scholars to reflect on work previously published in ANS, and use critical insights to present innovations in nursing theory, research, practice and policy. We encourage cutting edge ideas that challenge prior assumptions and that present new, intellectually challenging perspectives. We seek works that speak to global sustainability and that take an intersectional approach, recognizing class, color, sexual and gender identity, and other dimensions of human experience related to health.​
Artificial Intelligence & Robotics
Vol 42:4 –  December 2019
Manuscript due date: April 15, 2019
Artificial intelligence and robotics have been evolving in nursing for some time. We are planning to feature articles in this issue that address the relationship of artificial intelligence and robotics to patient outcomes and quality of care from a nursing perspective. We welcome philosophic analysis, including ethical implications, empiric research reports, and the development of innovative methodologies related to artificial intelligence. Articles must focus on the development of nursing knowledge that informs nursing practice, education and research.
Nursing Theory in 2020
Vol 43:1 –  March 2020
Manuscript due date: July 15, 2019 ​
The significance of nursing perspectives has gained renewed interest as social pressures to reform healthcare have created challenges for care that is more effective, more effective and more economically sound. In both theory and in practice, nursing offers possibilities that address each of these goals.  We are inviting articles that address the state of the art of nursing theory as we approach the third decade of the 21st century, revealing important contributions that nursing brings to create needed change. ​ We welcome articles addressing the full range of theoretic development: articles that report empiric research structured from existing nursing theories, philosophic analyses related to theory and knowledge of the discipline, critiques of existing theoretical approaches, and descriptions of new and evolving nursing theories.  
Best Evidence for Nursing Practice
Vol 43:2 –  June 2020
Manuscript due date: October 15, 2019 ​
Even though the ideal of practice based on evidence has flourished over several decades, the achievement of consistently sound practice, in nursing and in other disciplines as well, still eludes even the most well-intentioned practitioners.  For this issue of ANS we seek manuscripts that explore this dilema, examing questions such as ‘what constitutes evidence?” and “what constitutes the best evidence?” We also seek manuscripts that provide exemplars of best evidence and best practices. 
Methods for Nursing Knowledge Development
Vol 43:3 –  September 2020
Manuscript due date: January 15, 2020
We seek innovative approaches to knowledge development in relation to all patterns of knowing in nursing. We also welcome manuscripts that critique any methodologic approach, manuscripts that explore the philosophic, including ethical underpinnings related to the development of nursing knowledge, and manuscripts that address the critical connections between practice and knowledge development approaches. 
Humanizing Precision Science
Vol 43:4 –  December 2020
Manuscript due date: April 15, 2020
One of the trends of our time is the development of “precision science” – a trend that deserves careful consideration going forward. We seek manuscripts for this issue that provides assessment, explanation, evaluation and critique of this trend in light of the underlying foundations of nursology. This featured topic intentionally calls for both rigor and creativity that provides avenues for discussion and possible new directions in the development of our discipline. 

Structuring Nursing Knowledge


The current ANS featured article presents a new way of structuring nursing knowledge.  It is title “The Nursing Knowledge Pyramid: A Theory of the Structure of Nursing Knowledge” by Veronica B. Decker, DNP, PMHCNS-BC, MBA and Roger M. Hamilton, PhD.  This article is available to download at no cost while it is featured, and I join the authors in inviting you to post your comments here, and to join in a discussion of their work!  Dr. Decker shared this message about the evolution of this work:

Veronica Decker

The idea for the Nursing Knowledge Pyramid started in the fall of 2012 when I was in my first semester of a Doctor of Nursing Practice (DNP) program at Wayne State University. I was going to school full time and working full time. I was (and still am) living in Orlando Florida and I attended my courses synchronously on-line. The internal visual I maintain from this time includes seeing my cohort in their classroom seats in downtown Detroit, while I was in front of my lap top video cam in the den of my home, in sunny Florida. Most of the time, my fellow classmates would instant message me that they were a little jealous of the weather.

I was taking a course on foundations in nursing from doctors Nancy George and Rosalyn Peters when my work on knowledge development started. I was trying to get my head around integrating philosophical and theoretical perspectives of nursing to create a solid foundation for nursing practice and meet the requirements of an assignment for the course, which included a very detailed rubric. The paper I submitted to my professors was titled Toward a Theory of Cancer Coping. I titled it after Imogene King’s 1971 – Toward a Theory for Nursing: General Concepts of Human Behavior in mind. It made sense to me because I realized my ideas weren’t fully established yet, but I had made a solid start. This first document included a concept map that aligned King’s conceptual system with my own nursing system model, which included the Nursing Knowledge Pyramid. Over the next two years, nearly every assignment even remotely asking for use of theory, I would continue to enhance and better define this work.

As many of you know, DNPs are required to complete projects rather than the traditional PhD dissertation. To meet the requirements of my program, I completed two projects. A clinical performance improvement project (Decker, Howard, G.S., Holdread, H., Decker, B.D., Hamilton, R.M. 2016). and a theoretical application by developing a practice theory called Substructing a Cancer Coping Rule-base, which included the Nursing Knowledge Pyramid.

The Nursing Knowledge Pyramid (NKP) is a practical approach to support nursing practice. In my DNP program I was able to use the pyramid as a means of bridging the gap between theory and practice. As an experienced psychiatric mental health advanced practice nurse (APRN), I could operationalize the research project by methodically going from abstract knowledge (bottom of the NKP) to the concrete knowledge (top). The abstract level of the project was my knowledge as an APRN developed over my 30 years of experience. The middle tiers indicate the theoretical underpinnings and evidence-based practice. The most concrete knowledge at the top of the pyramid was the rule-base used to offer my patients coping strategies to handle their distress. Most recently we utilized the NKP to help develop the key conceptual relationships and theoretical foundation for a case study where the patient had an unrealistic fall risk appraisal. The patient was treated with a feedback strategy to reframe her perception of risk of falling. I’m interested in feedback from others who are considering using the NKP in their research.

References

Decker, V.B., Howard, G.S., Holdread, H., Decker, B.D., Hamilton, R.M. (2016). Effects of an Automated Distress Management Program in an Oncology Practice. Clinical Journal of Oncology Nursing, 20(1), e9-15.

King, I.M. (1971). Toward a Theory for Nursing: General Concepts of Human Behavior. New York, NY: Wiley.

Nursing Health Assessment Using Storytelling


The current ANS featured article reports a project that demonstrates how storytellng as a means of assessment has the potential to expose the complexities of health experiences that are not readily uncovered using standard assessment approaches.  The article is titled “Narrative Inquiry Into Shelter-Seeking by Women With a History of Repeated Incarceration: Research and Nursing Practice Implications,” authored by by Amanda Marie Emerson, PhD (English), PhD (Nursing), RN.  Dr. Emerson shared this information about her work:

I had the enormous good fortune during my PhD program in nursing (2017,

“The Sexual Health Empowerment (SHE) for Cervical Health Literacy and Cancer Prevention study team, December 2017: (Back row) Katherine Gwynn, Amanda Emerson, Molly Allison, Brynne Musser. (Front row) Joi Wickliffe, Megha Ramaswamy (PI), Shelby Webb. Used by permission.

University of Missouri-Kansas City) to become part of an interprofessional team (RNs, public health professionals, health educators, medical residents, social workers, a sociologist, and even a historian!) doing cervical cancer prevention research led by Dr. Megha Ramaswamy (PI) at the University of Kansas Medical Center, and my mentor Dr. Patricia Kelly (Co-I) (UMKC). The Sexual Health Empowerment (SHE) study, funded by the National Cancer Institute, sought to learn whether a interactive, trauma-informed, small-group intervention centered on cervical health literacy and feminist principles would increase up-to-date Pap screenings among women detained in county jails. We implemented the program with successive cohorts of women over 2 years beginning in 2014 and have been following up for 3 years. In addition to my role in the intervention itself, I took part in an ethnographic sub-team that conducted interviews and participant observation with a group of volunteers in the community after their release.

The Advances in Nursing Science article reports on a series of particular interviews I conducted with those women. We were initially impressed by the variety of strategies women used in highly challenging circumstances (i.e., poverty, physical and emotional abuse, child separation, even during incarceration) to get and give social support to one another. In my analysis of the interviews—a course of coding, reiterative reading for themes, memoing, discussion with team members—a particular set of stories coalesced. Almost to a woman, the participants in our follow-up research struggled to find secure housing when they returned to the community. This basic need drove many of the stories they told, organizing how they perceived and interacted with others and impacted how they understood choices related to their health and safety. It bears noting that I have a background in literature as well (PhD, 2004) where I learned to recognize the power of stories to give form to versions of self and other, to shape feeling and motivate behavior. The stories about shelter-seeking told by women with histories of repeated incarcerations in this study were not long, but they were rich in implications for the women’s health. The analysis I present in this narrative inquiry maps a couple key trajectories the stories about shelter seeking take and serves as a call to nurses who work with women in the community who may have backgrounds involving incarceration. I urge nurses to listen up, to make stories part of the assessment. As my analysis illustrates, those narratives can carry otherwise unavailable information about threats to health and safety and open up valuable opportunities for nurse-led education and advocacy.

 

Planned featured topic: Nursing Theory for 2020


The significance of nursing perspectives has gained renewed interest as social pressures to reform healthcare have created challenges for care that is more effective, more effective and more economically sound. In both theory and in practice, nursing offers possibilities that address each of these goals.  We are inviting articles that address the state of the art of nursing theory as we approach the third decade of the 21st century, revealing important contributions that nursing brings to create needed change.  We welcome articles addressing the full range of theoretic development: articles that report empiric research structured from existing nursing theories, philosophic analyses related to theory and knowledge of the discipline, critiques of existing theoretical approaches, and descriptions of new and evolving nursing theories. Manuscripts are due by: July 15, 2019, but are welcomed any time!

Caring for People with Dementia


Our current featured article is a report of a phenomenological, hermeneutic investigation titled “Former Work Life and People With Dementia” authored by Bente Nordtug, PhD, MA, RN; Karin Torvik, PhD, MA, RN; Hildfrid V. Brataas, PhD, MA, RN; Are Holen, PhD, MD (psychiatrist); and Birthe Loa Knizek, PhD, MA.   The research team was led by Dr. Bente Nordtug, a registered nurse, specializing

Bente Nordtug

in dementia care. She has a PhD in Health Science from Norwegian Science and Technology University (NTNU). Currently she works as an associate professor at the Department of Nursing and Health Sciences at Nord University (NU). Her research has mainly concerned issues such as the mental health of informal caregivers of patients, and how social support affects the caregivers’ caring burden.

This article is available to download at no cost while it is featured!  We invite all comments and ideas related to this work – leave you message below!

Healing Genocide Rape Trauma


Our current featured article is representative of a long ANS tradition – articles that address topics that are rarely brought to public attention.  The article is titled “Genocide Rape Trauma Management: An Integrated Framework for Supporting Survivors” authored by Donatilla Mukamana, PhD, RN; Petra Brysiewicz, PhD, RN; Anthony Collins, PhD; and William Rosa, MS, RN, LMT, AHN-BC, AGPCNP-BC, CCRN-CMC. The article is available for download here at no coast while it is featured. Dr. Mukamana shared this information about the background of this article:

The idea of writing about  genocide rape trauma came after a discussion I had with one of my patients in 2000. She had been gang

Donatilla Mukamana

raped and contaminated with HIV during the genocide against Tutsi in 1994,  At that time we met in 2000 she  was  dying.

She told me: “ Go and tell the world about the unspeakable cruelty of genocide rape which leaves the victim as living dead… then those who are in power should  prevent the occurrence of rape”

Rape used as a weapon of genocide affects all aspects of the survivor’s life. Therefore the healing process requires a holistic approach, one that I attempt to present in the current article.

I join the authors in welcoming your ideas, comments and questions about this work in the “comments” section below.

End-of-Life Communication


The current ANS featured article is titled “End-of-Life Communication: Nurses Cocreating the Closing Composition With Patients and Families” by Mary J. Isaacson, PhD, RN, CHPN and Mary E. Minton, PhD, RN, CNS, CHPN.  This article also is the first ANS continuing education offering, and the article is available to download at no cost while it is featured.  Here is Dr. Isaacson’s message about this work, which includes the authors’ own stories of end-of-life relationships:

Professionally both authors promote the importance of early and frequent communication with patients and families about their wishes or healthcare goals. Our personal lives have enriched and informed our passion. We’ll take this opportunity to give you a brief snapshot of two contrasting personal experiences. It is our hope that these experiences will inspire you to read our article on end-of-life communication. We will begin with Mary Isaacson’s personal account of an experience, where she tells of the challenges of honoring the patient’s wishes, while at the same time preparing the family. We conclude with Mary Minton’s personal story of being with her father and siblings during their father’s final weeks.

Mary Isaacson:

As a former rural hospice nurse, I was privileged to provide end-of-life care to patients and families in my home community. Through this experience, I learned that simply because of my rural location and staffing, I might be related to or know very

Mary Isaacson

well many of the patients and families entrusted into my care. Though no longer actively providing hospice care, this unique skill-set, (e.g., presence and communication) became pivotal as I worked with my husband’s Uncle Don in March 2017. Uncle Don, a retired Air Force Master Sergeant, Vietnam and Korean War Veteran, was diagnosed with recurrence of his lung cancer from 6 years ago. He was not tolerating the oral chemotherapy and had decided to enter into hospice care. My husband and I traveled from South Dakota to Idaho to say our “final good-byes.” Upon our arrival, Uncle Don promptly informed us that his oncologist felt that there was one more treatment that he should try. As Uncle Don stated, “She’s my oncologist. She knows what’s best and I really like her. So, I am going to do it.”

Our Aunt Donna, however, was less than enthusiastic about the prospect of more chemo. She shared how weak Don had become over the past 4 months. She feared that she would awaken to him “dead” beside her. Her words, “He’s dying. I don’t want to lose him, and I don’t want him to have the chemo either. But, I’m not going to tell him that.”

Over the 4 days that we spent with Uncle Don, Aunt Donna, and their cherished grandson’s family, I knew I had to help them begin to communicate their wishes to each other. One way I engaged Uncle Don in one-on-one conversation was while performing head and hand massage. We reminisced and talked about his future. In these conversations, he remained deeply

with Uncle Don

committed to trying another round of chemotherapy. On the other side, Aunt Donna remained fearful of their future. She could see, along with her grandson and his wife, the physical deterioration of Uncle Don and asked for guidance as to what to do. I prepped them in the questions (e.g., prognosis, likelihood of remission with the chemotherapy, quality of life, palliative care consult) to ask the oncologist at their next visit. When we returned home to South Dakota, I left with a heavy heart knowing that I wasn’t able to help them speak to one another. However, I was somewhat comforted knowing that I had prepared Aunt Donna and her grandson in what to do when Uncle Don’s condition deteriorated.

Two days later, Uncle Don was too weak to get out of bed. They transported him via ambulance to the hospital, where among the plethora of diagnostic tests and consults with specialists, his grandson successfully advocated for and they received a palliative care consult. His condition was stabilized enough for him to return home and with the help of hospice, he peacefully died 5 days later, in his home surrounded by his family.

This story, while difficult, portrays the importance of honoring the patient’s wishes, while also being realistic about the disease trajectory. Even though Uncle Don wasn’t ready to accept that cure was no longer possible, Aunt Donna was. Thus, my communication varied between the two. For Uncle Don, I provided a listening ear for him to share his legacy; for Aunt Donna and her grandson, we developed a plan to help them prepare for his death.

Mary Minton:

I was most fortunate. My parents were united in a pragmatic belief about advance care planning—although that term was never used. They routinely reviewed their advanced directives, asked me and my siblings to choose in advance sentimental items we might want, and they planned their memorial services.  Having survived the Depression Era, they saved wisely and

Mary Minton

lived sparsely. In their retirement years, Mom and Dad continually downsized. Following Mom’s death, my Dad kept this rhythm, sometimes to our chagrin when we still wanted something of Mom’s. However, his German preference for orderliness was such that my sister and I needed only a couple days for discarding or distributing my father’s belongings following his death.

My siblings and I supported our parent’s end of life wishes, as did their long time family practice doctor. My mother died of a chronic respiratory condition at the age of 87.  When I arrived for a weekend visit after not seeing her for nearly 6 months, I immediately sensed her struggle to stay alert. Her breathing was quite labored, yet she greeted me at their apartment door with her trademark smile and open arms.  As she and Dad watched TV that evening, I rubbed her feet and clipped her toenails (the home health nurse in me!).  She was coherent but her breathing was labored and she was flailing her arms occasionally. I queried Dad about this behavior—was this her norm lately, I asked?  He calmly replied yes.  He was her abiding caregiver and though we didn’t talk about her dying process, we both knew what was happening. A peaceful gratitude for simply being together prevailed.  The next morning Mom died in bed with Dad beside her. As her parting gift, she had waited for me to come home.

Following Mom’s death, Dad’s planning was once again in high gear as he enlisted my sister’s help in ensuring his estate and

with father and siblings

his will were updated and accurate.  I followed Dad’s health care needs during the next four years and my sister handled the financial details. Our brother offered moral support. At the age of 92. Dad’s health declined following a hip fracture. In the final six months of his life he transitioned from independent living to assisted living to skilled care. In that journey his cognitive ability declined and culminated in a hospitalization for delirium. His family doctor advised a palliative care consult and I remain forever grateful to the compassionate and skilled palliative care physician who guided the final steps of my Dad’s life which included a 2 week stay in hospice. I have poignantly beautiful memories of the nurses (who firmly but kindly encouraged me to be the daughter rather than the nurse), the social worker who acknowledged feelings I could not yet name, the music therapists who touched Dad’s soul with cherished hymns, the therapy dog, and pastoral care.

As both a recipient and observer of Dad’s skillfully orchestrated care, I had been given a ringside seat to experiencing the best of advance care planning, palliative and end-of-life care. Dad’s last days were marked by a peaceful acceptance of his dying process and cherished moments spent with my siblings. My parents’ legacy includes their example of how to live and how to die.

 

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