guilt, hospice nurse, residential care, transitions



  1. Martz, Kim PhD, RN


Transitioning elderly family members enrolled in hospice care to and between home, assisted-living facilities, and nursing home facilities at the end-of-life may induce a reciprocal type of suffering for both the elderly dying persons and their families. Glaserian grounded theory was used to examine how hospice nurses experienced and perceived caring for patients and their family caregivers during care transitions. A sample of 16 participants included 13 hospice nurses, 1 hospice social worker, 1 skilled nursing facility social worker, and 1 assisted-living facility nurse. In addition, 4 nurses received follow-up interviews, and 2 theoretical interviews were conducted after the model was developed and totaled 22 interviews. Findings described the actions of the nurses utilizing the situation-specific model of the basic social psychological process that families experience as a scaffold. Results revealed the specific therapeutic actions of the hospice nurses as actions of hospice nurses to alleviate guilt in family caregivers: supporting the transition. Actions in alleviating guilt included advocating, navigating the complexities of both facility systems and families, and especially coaching during the dying process. The results have educational implications for hospice nurses and interdisciplinary teams supporting family caregivers through these difficult transitions.