Healthy death readiness: development of a measurement instrument
The purpose of this study was to establish whether or not readiness for death, as an indicator of healthy dying, is a measurable concept. A theory of healthy death readiness was derived from the Rogerian Paradigm. The theory related healthy human individual field pattern with healthy death readiness. An instrument, the McCanse Readiness for Death Instrument (MRDI) was constructed which was intended to holistically measure physiological, psychological, sociological, and spiritual indicators of healthy field pattern as death was developmentally approached. A pilot study was conducted with a sample of nine volunteer patients drawn from a small suburban outpatient hospice. The MRDI was concurrently administered to dying individuals, their primary care givers, and their primary hospice nurses. Correlations between dying individuals' scores and their primary care giver estimates of patient death readiness, and between patient and primary hospice nurse were very encouraging. A Cronbach's alpha was used to test for internal consistency and was.591. The MRDI was then administered to a sample of 31 terminally ill individuals, their care givers and primary nurses, drawn from larger, urban, hospice populations in three geographic areas of the United States. The MRDI was also administered to a contrast group of 39 cardiac impaired individuals who were not terminally ill. Validity analysis included a Pearson's product moment coefficient relating dying individuals' scores with those estimated by primary care givers (.353, p =.026), and primary hospice nurses (.525, p =.002), and a t -test for difference between terminally ill individuals' mean scores and cardiac impaired individuals' mean scores (f = 2.76, p =.003). A t -test was also done to test for differences between dying individuals' original scores and their retest scores (1.19, p =.769). As a promising measure of healthy death readiness, the MRDI has implications for the promotion of effective, compassionate, and individualized nursing care of the terminally ill. A death readiness instrument could also be used to evaluate ways in which care settings for dying individuals should be structured. A measure of healthy death readiness could provide both ethical and legal justification for the controversial passive euthanasia component of hospice care.