Loss of potential participants limited this study and hampered effect size. Research with home hospice patients required careful assessment for symptoms that precluded informed consent. Issues with cognition indicated need for a tool to assess mental acuity. Although several participants required assistance, those who completed testing expressed gratitude at being able to contribute information that they believed would benefit others.

As part of a triangulated study that examined psychological adaptation in home hospice patients, the grounded theory method was used to generate social-psychological processes of dying. The pattern of the becoming-self was one of seven patterns that emerged. The responses and reactions of 15 dying persons described a pattern that was shaped by self-integration, inner cognition, creation of personal meanings, and connection to others and a higher being. The becoming-self supported humanism and veritivity as defined in adaptation nursing theory.

The findings support the need for hospice/palliative care professionals to approach spirituality from other than a Judeo-Christian viewpoint, help dying persons create meaning and purpose within the context of their lives, and assist them in their desire for connectedness to faith communities and other significant individuals in their lives.

Secondary analysis of data from a previous study that referenced spirituality was coded, categorized, and grouped into themes. Life-closing spirituality for 44 (45.4%) of 97 total participants was shaped by a core theme of believing that was central to dying persons. Believing was linked to six other themes: comforting, releasing, connecting, giving, reframing, and requesting. These themes supported the philosophic assumptions and principles of humanism and veritivity as defined in the Roy adaptation model.

This paper presents a middle-range theory of psychological adaptation in death and dying that was abstracted from a series of quantitative and qualitative studies. The findings from these studies are described, a conceptual definition for end-of-life psychological adaptation is given, evidence is synthesized into a limited number of assumptions, testable hypotheses are derived, and the constructed middle-range theory is linked to the conceptual-theoretical framework of the Roy adaptation model.