Exploring meaning-making among the terminally ill through the lens of transformative learning theory and the medium of personal narratives

Although various meaning perspectives have been studied among terminally ill patients, there remains a paucity of research regarding meaning-making or the way in which patients arrive at and challenge these perspectives. The purpose of this study was to investigate how meaning was formed and transformed between four dyads of hospice patients and nurses through the lens of Mezirow's Transformative Learning Theory.;Drawing from a convergence of evidence including life history reviews, personal narratives, nurse journal entries, and interviews, this study investigated how four patients habitually made meaning of crises throughout life and how these habits of mind influenced meaning-making around death and dying. Narratives were found to provide nurses with important insights about how patients typically formed meaning around crises, clues about how they might transform problematic assumptions, and a starting point for meaningful dialogue.;Patients who transformed their sense-of-self throughout life were found to be better conditioned in the art of inviting diverse perspectives and transforming problematic assumptions around dying. Patients whose sense-of-self had become more entrenched or rigid throughout life, were still found capable of transforming fundamental meaning around dying, though it required a greater sense of urgency, a willingness to share narratives, and a daringly empathic witness capable of opening and closing difficult conversations.;Transformative learning occurred in three out of four cases in which patients shared narratives and entered dialogue with nurses. Two out of four nurses in this study demonstrated a proficiency of reflecting on experiences characterized by personal loss, and carrying these emotions forward in order to authentically access and appreciate the emotional aspects of meaning in patient narratives. By identifying an intimate side of themselves within the patient, nurses promoted trust, empowerment, and self-reflection, which resulted in a newfound sense of liberation, self forgiveness, and humor among patients. Nurses reported enhanced job satisfaction due to the rewarding experience of learning from patient narratives and helping them arrive at a greater sense of comfort.