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cultural competence, ethnonursing research method, hospice, palliative care



  1. Mixer, Sandra J. PhD, RN, CTN-A
  2. Fornehed, Mary Lou MSN, RN, ACNP-BC
  3. Varney, Jason MSN, RN, FNP-BC
  4. Lindley, Lisa C. PhD, RN


While death is a universal human experience, the process of dying amplifies cultural similarities and differences. There is insufficient evidence about providing culturally congruent end-of-life care for rural Appalachians. Such care is satisfying and meaningful, fits with people's daily lives, and helps them face death. This study addressed this knowledge gap, and its findings can serve as the basis for developing strategies to promote a satisfying death experience for people within this underserved cultural group. The purpose of this study was to describe generic (folk) and professional (nursing) factors that health care workers can apply to provide culturally congruent end-of-life care for people in the East Tennessee region of rural Appalachia. Guided by the culture care theory and the qualitative ethnonursing methodology, 15 participants (persons receiving hospice home care, family members, nurses, administrators, and interdisciplinary team members) were interviewed. Data were analyzed using the 4 phases of ethnonursing analysis. Themes abstracted address rural Appalachian culture care needs at end of life related to faith, family care, integrating generic/folk care with professional nursing care, and hospice care decision making. Recommended nursing interventions promote physical, emotional, and spiritual health; address health disparity; and aid in dignified death for rural Appalachian people and families.