Based on nearly three years of participant-observation research in hospice settings, factors that interfere with the hospice philosophy of providing patient autonomy include efforts at symptom control, patient residence, patient disease state, and staff limit setting. Discusses examples, implications, and staff attempts at solutions. (JPS)

Participant-observation research was conducted in the home care components of a free-standing inpatient facility associated with several hospice organizations over three years. The data are reported using negotiated order theory as a framework for understanding the hospice movement and its attempts to change the experience of dying. (JPS)

This study sought to identify from the literature the type of preparation nurse practitioners receive and the practices they use in the care of terminally ill patients as well as to determine from a study of five practitioners in rural health clinics in Mississippi their perception of their training, their philosophy, and the strategies they use…