Florida State University Libraries Electronic Theses, Treatises and Dissertations The Graduate School 2009 The Rewards and Challenges of Hospice Work Gina D. Carreno-Lukasik Follow this and additional works at the FSU Digital Library. For more information, please contact [email protected] FLORIDA STATE UNIVERSITY COLLEGE OF SOCIAL SCIENCES THE REWARDS AND CHALLENGES OF HOSPICE WORK By GINA D. CARRENO-LUKASIK A Dissertati n submitted t the Department f S ci l gy in partial fulfillment f the re,uirements f r the degree f D ct r f Phil s phy Degree Awarded. Summer Semester, 0112 The members f the C mmittee appr 3e the Dissertati n f Gina D. Carren -Lu4asi4 defended n April 17, 0112. ______________________________ 8ill 9uadagn Pr fess r Directing Dissertati n ______________________________ Charles Barrilleau: Outside C mmittee Member ______________________________ 8im Orcutt C mmittee Member ______________________________ Irene Pada3ic C mmittee Member Appr 3ed. ______________________________________ Irene Pada3ic, Chair, Department f S ci l gy _______________________________________ Da3id Rasmussen, Dean, C llege f S cial Sciences The Graduate Sch l has 3erified and appr 3ed the ab 3e named c mmittee members. ii F r Al iii ACKNOWLEDGMENTS First, I must than4 my c mmittee chair, 8ill 9uadagn , f r her dedicati n and enc uragement thr ugh ut this wh le pr cess. 8ill, I can<t than4 y u en ugh f r being willing t step in years ag as my maj r pr fess r when circumstances sh c4ingly turned tragic. Y u always ha3e sh wn me c mpassi n, sensiti3ity, and supp rt. Y u ha3e inspired me t n t nly stri3e t be a better s ci l gist but als a better human being. I als than4 Patricia Yancey Martin f r her shining e:ample f what a true sch lar sh uld be > perse3erant, dedicated t s cial justice, and c nstantly stri3ing f r e:cellence. Pat, I ha3e bec me a str nger researcher because f y ur e:ample. Than4 y u s 3ery much t the members f my c mmittee f r their patience, understanding, and supp rt thr ugh ut this pr cess. Than4 y u t 8im Orcutt f r y ur w nderful balance between pr fessi nalism and appr achability. I will ne3er f rget ur research seminar during which y u handed me the ga3el f r editing s4ills. That ma4es me smile t this day? Than4 y u especially t Irene Pada3ic f r being willing t c me in t this c mmittee at this stage f the pr cess. I ha3e always c nsidered y u a r le m del f r h w t be n t nly an acc mplished s ci l gist but als a str ng, independent, acti3ist w man. Y u ha3e truly influenced my 3alues and thin4ing during these years. Than4 y u t Charles Barrilleau:, my utside c mmittee member, f r y ur interest in my t pic and belief in my ability t see this pr ject thr ugh. I truly appreciate y ur willingness t be a part f this c mmittee amidst all y ur ther resp nsibilities. I als wish t than4 8amie Yeargan f r helping me thr ugh the nuts and b lts f this s metimes-c nfusing pr cess. Y ur guidance (and friendly reminders?A ha3e helped 4eep me n trac4 when I felt li4e I was ab ut t fall ff. Than4 y u especially t all the h spice w r4ers wh 4indly t 4 time ut f their bey nd-busy li3es t sit d wn and tal4 with me f r this study. W rds cann t e:press h w much I truly appreciate y ur willingness t share y ur e:periences and feelings with me. I ha3e learned s much ab ut h spice and ab ut life fr m each and e3ery ne f y u. I wish y u all the 3ery best in all y u d . Than4 y u t all my c lleagues and friends with wh m I ha3e c llab rated and celebrated thr ugh ut these years. Y u 4n w wh y u are. I c uld ne3er ha3e made it thr ugh this pr cess with ut y u. An especially big than4-y u hug g es t Chris, my i3 h n rary sister. I am luc4y t ha3e met y u in c llege, and I am s glad that ur friendship has nly gr wn str nger thr ugh ut all these years. None f this w uld ha3e been p ssible with ut the endless l 3e, supp rt, and enc uragement f my parents. M m and dad, w rds can ne3er e:press h w much I l 3e y u. I am c nstantly reminded f h w blessed I am that y u are my parents. Than4 y u s 3ery much f r always being there f r me and belie3ing in me. I als than4 my ch sen family. Than4 y u s 3ery much t Greg Lu4asi4 > my husband, partner, c nfidant. I feel blessed that I met y u in graduate sch l, and I am grateful f r h w ur friendship grew int s mething e3en m re special and l ng-lasting. Than4 y u s much f r y ur endless supp rt, enc uragement, hum r, and l 3e. Than4 y u als t Kitty, wh always has gi3en me unc nditi nal l 3e. I 4n w y ur life bef re we met was heartbrea4ingly difficult. Than4 y u f r trusting me and all wing me int y ur heart, because y u certainly g t int mine. And finally, than4 y u t my daughter. I l 3e y u s much already, and I can<t wait t meet y u in a few m nths. I will d e3erything I can t fill y ur life with j y, laughter, and l 3e. I l 3e y u, baby. Finally, than4 y u t Allen Imershein > pr fess r, ment r, cherished friend. I am wh I am t day in large part because I was s truly blessed t ha3e 4n wn y u. The ne dar4 sp t in this m ment is that y u are n t here t share it with me. All f us wh 4new y u l 3ed y u and still d . Y u will li3e f re3er in ur hearts. I dedicate this dissertati n t y u. I h pe it ma4es y u pr ud. 3 TABLE OF CONTENTS Abstract i: 1. INTRODUCTION 1 Why Study H spiceB 1 Pers nal M ti3ati n 1 S ci l gical M ti3ati n 0 C ntributi ns f This Study C C ntributi ns t S ci l gy C C ntributi ns t H spice 5 O3er3iew f Dissertati n Chapters 5 0. BACKGROUND. THEORY AND RESEARCH 7 Stress in Paid W r4 7 R le C nflict 7 Typ l gies f R le C nflict E C nse,uences f R le C nflict 2 C ping Strategies 2 H spice W r4 10 H spice. Past and Present 10 Stress in H spice W r4 1C C nclusi n 17 3. RESEARCH DESIGN AND METHODOLOGY 12 Data C llecti n 12 Participants, Recruitment, and C nfidentiality 12 Table 3.1 Descripti3e Inf rmati n n Participants 01 Inter3iew 9uesti ns 00 Data Analysis 00 C. CONFLICTS BETWEEN WORKER AND CLIENTS 05 Death is Tab in the U.S. 05 C nse,uences f Death as Tab 06 Clients< Denial ab ut Impending Death 06 Clients HPr tectingI Each Other 07 Clients< Lac4 f Kn wledge ab ut Dying and Grie3ing 31 Clients< Desire f r Curati3e Treatments 33 C ping Strategies 3C Educating Clients 3C HY u G t H spice t DieI 3E C nse,uences f Misc ncepti n 32 H spice T Late 32 Self-Fulfilling Pr phecy C0 HNo M rphineI. Fears f Euthanasia C0 HGi3e Her the Sh tI. Re,uests f r Euthanasia CC 3i C ping Strategies CE Educating Clients CE Ac,uiescing t Clients 53 L 4ing the Other Way 57 Other P ssible S urces f C nflict 52 Culture and Religi n 52 Mental C nditi n f Patient 60 C ping Strategies 63 Remembering HIt<s Not ab ut Me, It<s ab ut ThemI 63 C nclusi n 65 5. HOSPICE BECOMING MORE LIKE A BUSINESS 67 E:pansi n 67 9uantitati3e R le O3erl ad 6E 9ualitati3e R le O3erl ad 73 H spice W r4 in Different Settings 76 C ping Strategies E2 Sacrificing Time with Clients E2 Aband ning Pr fessi nal S cialiJati n Acti3ities 20 Engaging in Impressi n Management 2C Di3isi n f Lab r 22 Alienati n f W r4er fr m H spice Pr cess 111 R le Ambiguity am ng Team Members 110 Irrati nal C nse,uences f r Clients 116 C ping Strategies 112 Keeping Lines f C mmunicati n Open 112 Remembering HIt<s Not ab ut MeK It<s ab ut ThemI 110 C st C ntainment 11C Internal C st C ntr l 115 E:ternal C st C ntr l 116 Threat t W r4er-Client Relati nship 117 Increased Need f r D cumentati n 112 No Curati3e Treatment 3ersus Open-Access 101 Pri ritiJing HMedicalI Care 3er HNon-MedicalI Care 103 C ping Strategies 10E Accepting Begrudgingly 10E Dec upling fr m Management 10E Educating Team Members 131 Educating Clients 13C Using Clients< Lac4 f Kn wledge t Y ur Ad3antage 135 Remembering HIt<s Not ab ut MeK Its ab ut ThemI 135 C nclusi n 136 6.