Date of Graduation


Document Type


Degree Type



School of Nursing


Adult Health

Committee Chair

Katherine J Buck

Committee Co-Chair

Gina Maiocco

Committee Member

Elisabeth Shelton

Committee Member

Mary Jane Smith

Committee Member

Debra Wiegand


Nearly 65 million Americans served as care provider to an ill or disabled adult, and over 1.6 million Americans participated in the care of a family member in hospice. Families experience transitions, or changes, throughout the serious illness trajectory. Throughout transitions in serious illness, families participate in the care, support, and decision-making for their ill family member. Families' lives are often disrupted during this time and families experience emotional, physical and psychological distress during transitions. In spite of this, families are rarely included in care, and little is known about how families make sense of transitions. Culture, and the factors that shape it, can impact family interpretations of illness and meanings of illness transitions. This qualitative study explored family descriptions of the influence of four cultural factors (kinship/family, knowledge systems, community/social systems, and faith/religion) on transitions in serious illness during an understudied transitional time span, from the point of diagnosis up to the EOL phase. Eleven participant interviews were gathered from twelve family members of persons recently deceased due to serious illness. Data collection and analysis were guided by the concepts of culture and transitions in illness and conventional content analysis methods. Seven themes emerged from the data that described the influence of cultural factors on family transitions in serious illness: (1) family takes care of family; (2) we're "going to fight this"; (3) "seeing" and experience were believing; (4) families "figured it out"; (5) community eased the family burden; (6) health professionals both eased and hindered family transitions; and (7) "God was always in the background". Findings support the need for provision of patient-centered, family-focused, culturally congruent nursing care to seriously ill persons and their families across the illness continuum. Implications for nursing education and research are also discussed.