A VOYAGE TO THE TWILIGHT: EXPLORING DEATH PREPARATION AMONG THE ELDERLY

A Thesis Presented to the Faculty of the Graduate School Virgen Milagrosa University Foundation San Carlos City, Pangasinan

In Partial Fulfillment of the Requirements for the Degree Master of Arts in Nursing Major in Administration of Nursing Service

CARLO PAUL C. SANA, RN

October 2012

APPROVAL SHEET This thesis entitled A Voyage to the Twilight: Exploring Death Preparation among the Elderly, has been prepared and submitted by Carlo Paul C. Sana in partial fulfillment of the requirements for the degree of Master of Arts in Nursing is hereby submitted for Oral Examination. Thesis Committee REMEDIOS V. FERNANDEZ, Ed.D, MAN Adviser
JIMMY G. CATANES, MPH Member JENNELYN V. RAMOS, PhD Member

ANALITA G. GONZALES, MPH, MAN Member Approved on October 21, 2012 by the Panel on Oral Examination on October 21, 2012 with the grade of 97. JOSE EMMANUEL C. MANDAPAT, D.A CHAIRMAN JIMMY G. CATANES, RPh., MPH Member JENNELYN V. RAMOS, RN, MAN, PhD Member

ANALITA G.GONZALES, RN, RM, MPH, MAN Member Accepted in partial fulfillment of the requirements for the degree Master of Arts in Nursing.
MA. LILIA POSADAS-JUAN, M.D., FPCHA President JOSE EMMANUEL C. MANDAPAT, D.A. Dean, Graduate School

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CERTIFICATE OF ADMISSION TO CANDIDACY FOR THE DEGREE MASTER OF ARTS IN NURSING

This is to certify that CARLO PAUL C. SANA was admitted to candidacy for the degree Master of Arts in Nursing as of Summer 2012 after passing the Comprehensive Examination in his Basic Concentration and Cognate Courses, given last March 26, 2012 with a grade of 97.

JOSE EMMANUEL C. MANDAPAT, D.A Dean, Graduate School

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CERTIFICATION OF ORIGINALITY This is to certify that the research work presented in this thesis entitled A VOYAGE TO THE TWILIGHT: EXPLORING DEATH PREPARATION AMONG THE ELDERLY for the degree Master of Arts in Nursing at the College of Graduate Studies of Virgen Milagrosa University embodies the result of original and scholarly work carried out by the undersigned. This thesis does not contain words or ideas taken from published sources or written works that have been accepted as basis for the award of a degree from any higher education institution, except where proper referencing and acknowledgment were made.

CARLO PAUL C. SANA, RN Researcher September 14, 2012

(Month, date year)

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ACKNOWLEDGMENT

The author would like to direct his earnest words of recognition, appreciation, and gratitude to the many whom he is much indebted to, for the encouragement, guidance, scholarly criticisms, support and succor they have rendered in the successful completion of his work. To Dr. Jose Emmanuel C. Mandapat, Dean of the Graduate School of Virgen Milagrosa University Foundation, for his valuable suggestions and administrative excellence; To his Thesis Adviser, Dr. Remedios V. Fernandez, for not only teaching him the process of Research, but also taught him the crucial lessons of life; for her encouragement, patience, and competence in providing guidance and constructive suggestions in every phase in the conduct of this study; To his research mentors, Professor Alison A. Gutierez and Professor Jimmy G. Catanes, for sparing most of their time imparting all their exhaustive ideologies on Research which led to the development of this modest work; To Professor Analita G. Gonzales, Dean of the College of Nursing of Virgen Milagrosa University Foundation, and Dr. Jennelyn V. Ramos, for the inspirations, guidance and scholarly suggestions in improving this masterwork; To all his classmates in Graduate School, for the encouragement, moral support and assistance in various ways; motivation,

The author also wishes to acknowledge his profound indebtedness to the following people nearest to his heart: foremost, to his ever-loving mother, Carmelita, his beloved sister, Carlea, his best friends / confidantes / significant others, Ms. Czarina Anne D. Posadas, Mr. Edwin V. Macanas, Ms. Jesusa Rosete, Mr. Rommel Cerezo, and Mr. Louie Arenas for all their undaunted inspirations, encouragement, financial and moral support, physical assistance and fervent prayers for his success. To his late father and grandmother, who have taught him on the most precious lessons of life: to be humble, to respect others, and to become a servant of God. To his relatives, especially Mr. Elpidio C. Castro for being an inspiration for him to pursue his dream of becoming a successful person. And above all, his devotions of gratitude to the Almighty Lord, for the strength, knowledge, and spiritual guidance given to him for the successful completion of this humble work.

C.P.C.S.

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ABSTRACT Title : A Voyage to the Twilight: Exploring Death Preparation Among the Elderly Researcher : Degree Institution Year Adviser : : : : Carlo Paul C. Sana, RN Master of Arts in Nursing Virgen Milagrosa University Foundation 2012 Remedios V. Fernandez, RN, RM, MaEd, Ed.D, MAN

Summary The study entitled, A Voyage to the Twilight: Exploring Death Preparation Among the Elderly was conducted to determine the philosophies and attitudes of the elderly in accordance with their ethnicities in relation to the physical, psycho-social, and spiritual aspects of death preparation. It also sought for the importance of having a support system as the elderly persons faced or are facing near-death experiences and / or terminal illnesses. The study is qualitative in nature, and it has utilized descriptive phenomenology as its research design. Informants of this study were from the different cities and municipalities of Pangasinan which included San Carlos City, Dagupan City, Urdaneta City, and Villasis. There were eight informants of the study. They were chosen through purposive sampling in the form of extreme case sampling. Four of them are pure Ilocanos, and the other four are pure

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Pangasinenses. There was no preset number of informants. Instead, data was exhausted until saturation point was reached. This was a point in data gathering where no new data was obtained. All of them have been involved in a near-death experience and / or are in a dying state. This extreme case criterion was made in order for the researcher to determine his informants preparations while they are going through such trials on death and dying. The researcher studied the way of living of each informant before they were interviewed. He made use of social integration as a strategy to do this by being one with the people he wished to deal with (in this case, his informants). This was done to build rapport. Data was gathered in the form of a semi-structured interview by utilizing standardized open-ended questions.

Findings During the entire process of the study, the researcher has found out various concepts on death and death preparation perceived by the elderly persons in relation to their ethnicity and support system. The study also entailed their own definitions of death, and the process that they undergo when experiencing a loss (near-death experience for their cases), since they have lost their health and, are going through or have undergone a near-death involvement. The study found out that the elderly population has acknowledged death to be inescapable, thus everyone will undergo through this stage of life. Another

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delineation of death according to them is that, it serves as a way in entering their Creators Kingdom. The informants of the study have experienced a grieving process. The informants have gone through six stages of the process which included the following in order: Denial, Anger, Realization, Bargaining, Depression, and finally, Acceptance. These stages were met during their struggles with the near-death experiences that they had and/or are having. These stages of the grieving process were adopted from Elisabeth Kubler-Ross Theory, which included denial, anger, bargaining, depression, and anger alone. Moreover, the researcher has found another stage that the informants have undergone, which is the realization stage, where they have realized the causes and effects of their illnesses. The study also explored further into the elderly populations cultural attitudes as they have been facing death. The researcher found out that both Ilocanos and Pangasinenses have following attitudes regarding death

preparations: They are passive / dependent to their significant others in terms of death preparation, leaving it all up to them when they die eventually; they also are family-oriented in a way that they still wanted to live because of their will to be with their families still; and lastly, believe that God extends life. Separately, elderly Ilocanos are optimistic regarding their near-death experiences because of their notion that they will somehow surpass those trials. Elderly Pangasinenses

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on the other hand, are peace-seekers because they wanted to die without any burdens in their hearts. Finally, the study also reconnoitered further on the effects of having a support system with them, and the informants said that support system serves as a cure because without them, there will be no one to take good care of them while they were ill. Another significance of having a support system during a serious illness is that, it strengthened their personal relationships with each other.

Conclusions When thoughts of fear and uncertainty flourish during ones journey to an end, it indicates a certain degree of unpreparedness. However, when a dying person who considers certain factors in helping himself / herself cope with the stress of dealing with the previously-stated sentiments then chances are, those gushes can be minimized or even relinquished from his / her contemplations. Three factors known to have helped the informants in coping with the distress that they have gone through / been going through are God, their Significant Others, and the Philosophies that they have cultivated all throughout their elderly lives. Those three factors made a huge impact on the preparedness of elderly as they get near to the end of life. The researcher has categorized these three factors within the lexis, imperative key. In relation to this section of the study, Scharlach et.al, have concluded in an article entitled Curriculum Module on Aging and Ethnicity, that the cohort of

minority persons who are now elderly has experienced a unique history, typically including substantial family and social involvement, problems associated with immigrant status, as well as great perseverance in the face of racism and institutionalized prejudice. Minority elderly persons are generally identified as members of four non-European populations: African-American, Hispanic, Native American, and Asian/Pacific Islander. The unique assets and problems of minority elders have, to a large extent, been ignored by mainstream social scientists, policy makers and service providers. There is a need for accurate, relevant knowledge regarding minority elders in order to assure that the needs of all older persons are adequately met and understood. (Scharlach, FullerThomson, & Kramer, 2002) The researcher of this study therefore concludes that the imperative key has made an impact in the elderly persons lives as they face the changing temporalities of time. The imperative key paved its approach to convey an

influence change on the informants view of death through: a newly-formulated meaning of death according to them, the sequence that they undergo during

the grieving process, the attitudes that make them up as an elderly who have had near-death experiences in relation to their ethnicity, and the effects of having a support system with them as they face the challenges of the changing time. The researcher also concludes that the elderly have their own views towards death preparation in terms of their ethnicity. Ilocanos are optimistic in nature, while Pangasinenses are Peace-seeking individuals. However, in

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comparison, they both are dependent individuals, family-oriented individuals, and individuals who believe that God helps them in extending their lives. The researcher also adds up into his conclusion that an individual with an adequate support system makes them feel recovered and feel that their relationship with each other gets stronger as well. These conclusions have satisfyingly answered the researchs statement of problems which included the following: First, what are the philosophies of the elderly on death preparation as affected by their ethnicity in terms of the physical, psycho-social, and spiritual aspects? And lastly, what is the effect of support system in an elderly who faces death?

Recommendations Based on the findings and conclusions drawn from this study, the following are the recommendations: The study was conducted by having elderly informants who have encountered near-death experiences or are dying as its informants regarding their death preparations. The researcher recommends a similar study having teenagers or other age groups as its informants. With ethnicity and support system as the main focus of this study, particularly on how these two factors affect the elderlys preparations on death, the researcher recommends conducting a similar study about how the elderly populations preparation on death is affected by other factors such as their

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economic status, gender, religion, and the like. Moreover, since the study utilized informants with a support system, it is recommended to conduct a similar study however, with those elderly persons living alone. Moreover, the researcher also recommends future researchers to conduct future ethnographic designed qualitative researches similar to the study, and to have more contacts with their informants, so that cultural diversity can be deeply analyzed through the process of observation as well, and not merely depending on the interview process alone. This has been recommended by the researcher because of the limited contact times that he had with his informants due to restricted time and heightened circumstances (presence of typhoons during the conduct of the research).

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TABLE OF CONTENTS Page TITLE PAGE APPROVAL SHEET CERTIFICATE OF ADMISSION TO CANDIDACY FOR THE DEGREE MASTER OF ARTS IN NURSING CERTIFICATION OF ORIGINALITY ACKNOWLEDGMENT ABSTRACT CHAPTER I INTRODUCTION Background of the Study Importance of the Study Researchers Background Statement of the Problem Hypothesis CHAPTER II METHODOLOGY Research Design Sources of Data Research Setting Sampling Research Instrument Instrumentation and Data Collection 14 15 15 17 22 22 1 8 10 13 13 iii iv v vii i ii

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Trustworthiness Data Management and Analysis CHAPTER III RESULTS AND DISCUSSION Meaning of Death The Sequence of Living in a State of Dying Philosophies of an Elderlys Soul Significances of a Support System Limitations and Implications Conceptual Map of the Study CHAPTER IV REVIEW OF LITERATURE AND STUDIES Related Literatures Foreign Local Related Studies Foreign Local Synthesis CHAPTER V SUMMARY, CONCLUSION, AND RECOMMENDATIONS Summary Conclusion Recommendations

27 32

34 37 46 54 58 59

60 71

76 82 84

88 91 93

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BIBLIOGRAPHY a. Books b. Journals c. Internet Sources APPENDIX Appendix 1: Letter of Notice Appendix 2: Standardized Open-Ended Interview Questions Appendix 3: Informed Consent CURRICULUM VITAE 101 103 106 100 95 96 97

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