Spirituality in advance directive decision making among community dwelling well older adults
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The following manuscript style dissertation, entitled Spirituality in Advance Directive Decision Making Among Community Dwelling Well Older Adults , presents three unitary and cohesive manuscripts. Manuscript III presents the method, design, and findings of the dissertation study. The purpose of this qualitative grounded theory study was to investigate the meaning and definition of spirituality as well spirituality's role in end of life care among community dwelling well older adults in relation to advance directive decision making (ADDM). The primary aims of this study were to: (1) describe the meaning and definition of spirituality with regard to ADDM from the perspective of the community dwelling well older adult; (2) explain factors constituting spirituality and ADDM among community dwelling well older adults; and (3) explain how community dwelling well older adults use spirituality to discuss decision making related to advance directive (AD) care planning needs. Erikson's (1963) eighth psychosocial developmental stage, Integrity versus Despair , and Blumer's (1969) Symbolic Interactionism Theory formed the theoretical orientation for this study and were used as guides during both interview question construction and in the analysis of data. Subjects were recruited through snowball sampling until data saturation occurred resulting in a sample of 12 participants. Data analysis consisted of detailed line by line comparative analysis using memoing and open, axial, and selective coding. Findings revealed that participants had to be specifically asked to describe spirituality and its role in advance directive care planning or just physical and emotional aspects of end of life care were discussed. Participants were willing to engage in deep discussion regarding the meaning and definition of spirituality and its role in ADDM when given ample opportunity to use story telling as their main means for communication. Spirituality was defined by study participants as a connection between contributing, supporting, and believing resulting in a dueled mirrored BSP, Spirituality as Connecting . Spirituality as Connecting was comprised of two BSP processes: Spirituality in Everyday Life (reflecting broad and global attributes and properties of wellness) and Spirituality as Connecting in Advance Directive Decision Makin g (reflecting narrow and succinct attributes and properties of illness).