Perceptions and Experiences of Rural, Homebound, Older Diabetics
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University of Tennessee, Knoxville TRACE: Tennessee Research and Creative Exchange Doctoral Dissertations Graduate School 12-2005 The Only Way Out Is To Die: Perceptions and Experiences of Rural, Homebound, Older Diabetics Sharon Robbins George University of Tennessee - Knoxville Follow this and additional works at: https://trace.tennessee.edu/utk_graddiss Part of the Nursing Commons Recommended Citation George, Sharon Robbins, "The Only Way Out Is To Die: Perceptions and Experiences of Rural, Homebound, Older Diabetics. " PhD diss., University of Tennessee, 2005. https://trace.tennessee.edu/utk_graddiss/1971 This Dissertation is brought to you for free and open access by the Graduate School at TRACE: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of TRACE: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. To the Graduate Council: I am submitting herewith a dissertation written by Sharon Robbins George entitled "The Only Way Out Is To Die: Perceptions and Experiences of Rural, Homebound, Older Diabetics." I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the equirr ements for the degree of Doctor of Philosophy, with a major in Nursing. Sandra P. Thomas, Major Professor We have read this dissertation and recommend its acceptance: Joanne Hall, Janet Witucki-Brown, Mary Ziegler Accepted for the Council: Carolyn R. Hodges Vice Provost and Dean of the Graduate School (Original signatures are on file with official studentecor r ds.) To the Graduate Council: I am submitting herewith a dissertation written by Sharon Robbins George entitled “The Only Way Out Is To Die: Perceptions and Experiences of Rural, Homebound, Older Diabetics.” I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the requirements of the degree of Doctor of Philosophy, with a major in Nursing. Sandra P. Thomas, Major Professor We have read this dissertation and recommend its acceptance: Joanne Hall Janet Witucki-Brown Mary Ziegler Accepted for Council: Anne Mayhew Vice Chancellor and Dean of Graduate Studies (Original signatures are on file with official student records.) THE ONLY WAY OUT IS TO DIE: PERCEPTIONS AND EXPERIENCES OF RURAL, HOMEBOUND, OLDER DIABETICS A Dissertation Presented for the Doctor of Philosophy Degree University of Tennessee, Knoxville Sharon Robbins George December, 2005 Copyright © 2005 by Sharon Robbins George All rights reserved ii DEDICATION This dissertation is dedicated to Dr. Sandra P. Thomas to whom I am grateful beyond measure. She is an exemplar of the ideals representative of nursing and sets a standard to which all nurses should follow. Dr. Thomas represents preeminence in research and teaching. She encourages and provides the freedom for her students to explore and discover perceptions, experiences, and meanings of the world in which nursing is grounded. She is a model of excellence who challenged my thinking and promoted nursing scholarship. This study would not have been possible without her continuous guidance, caring, wisdom, and humor. When I faced personal, difficult, circumstances, Dr. Thomas generously and selflessly gave her time and support. It was she who taught me to “keep on, keeping on.” Dr. Thomas embodies the characteristics of the quintessential nurse. iii ACKNOWLEDGMENTS It is with great appreciation and humility I thank the ten participants in this study. They graciously opened their homes and hearts to share their perceptions and experiences of a disease that causes them enormous sacrifice every day of their lives. I was privileged to have been surrounded with an extraordinary dissertation committee. Dr. Sandra Thomas, Chair, Dr. Joanne Hall, Dr. Janet Witucki-Brown, and Dr. Mary Ziegler made contributions individually and collectively to my doctoral education and this dissertation. They believed in and encouraged this research throughout its progression. Their support and confidence in me were sustaining throughout this study. I want to specially acknowledge my husband for his unfaltering devotion, during adverse circumstances, in helping me continue at the College of Nursing. He became a wonderful “nurse” and added new dimensions to the vow “in sickness and in health.” iv ABSTRACT The purpose of this phenomenological study was to investigate the meaning of diabetes, as perceived and experienced by rural, homebound, 65-year and older, diabetics requiring insulin. The sixty-five year and older persons are disproportionately affected by diabetes. They are more likely than younger diabetics to have co-morbidities, disabilities and difficulty preventing diabetic complications. Guidelines for diabetes management and treatment developed by the American Diabetes Association are not specifically targeted for the 65-year and older population. Phenomenological research was used to examine and describe the understanding of diabetes from perspectives of older diabetics. A purposive sample of participants was recruited from Senior Agencies referrals in a Southern State, following University of Tennessee Institutional Review Board approval. Participants were 65 years of age or older, female, required insulin, homebound, lived alone, lucid, English speaking, and willing to participate. Unstructured, audiotaped, face-to-face interviews were conducted individually in each person’s home. Thomas and Polio’s (2002) phenomenological method, which begins with bracketing, was used for collecting and analyzing the qualitative data in this study. Data was reviewed by the researcher and selected transcripts were read aloud to members of an interpretive, interdisciplinary, phenomenology research group at The University of Tennessee, Knoxville, to determine emerging themes described by the participants. The group assisted the researcher in identifying thematic structures from the data. This phenomenological study revealed that diabetes had forever changed lives. Four figural themes emerged; the predominant theme was “you just go on.” Remaining v themes were: “your body will let you know: if you miss it you’ll wind up in a coma;” I thought I was fine, but I wasn’t;” and “only way out is to die.” Participants seemed pleased to have the opportunity to describe their experiences to a professional health care provider. Their perceptions and experiences of living with diabetes led to introspection and existential questioning. The participant’s experiences were unique in quality and meaning. Based on the outcome of this study, this population requires a different approach to diabetes self-management. Understanding an older person’s perceptions and experiences with diabetes may provide a foundation for considering new diabetic protocols. Nursing interventions could include diabetes regimens planned with consideration of the context of the person’s life, which could be more efficacious than conventional regimens. vi TABLE OF CONTENTS Chapter Page I. INTRODUCTION ................................................................................................ 1 Stance of the Researcher ........................................................................................ 2 Problem .................................................................................................................. 3 Purpose ................................................................................................................... 3 Theoretical Perspective .......................................................................................... 4 Research Question ................................................................................................. 5 Limitations and Delimitations ................................................................................ 5 Significance of the Study ....................................................................................... 6 II. LITERATURE REVIEW ................................................................................. 10 Organization of the Chapter.................................................................................. 10 Diabetes Education .............................................................................................. 10 Diabetes Acceptance ............................................................................................ 15 Diabetes Self-Management .................................................................................. 18 Diabetes in 65-Year and Older Individuals .......................................................... 20 Rural Homebound Population .............................................................................. 23 Summary .............................................................................................................. 23 III. METHODOLOGY ............................................................................................ 25 Historical Perspective ...........................................................................................25 Research Design ................................................................................................... 28 Sample Selection .................................................................................................. 29 Characteristics of the Sample.................................................................... 31 vii Procedure