• Breathing lessons: An exploration of caregiver experiences with dying patients who have air hunger

      Tarzian, Anita Jeanne; Neal, Maggie T. (1998)
      Breathing has been viewed, religiously and metaphorically, as symbolic of life--living and dying into each moment through inspiration and expiration. One possible breathing pattern before death is referred to in medical slang as "air hunger." This is an extreme form of breathlessness in which a dying patient panics and perceives having no control of his or her breathing. In this interpretive phenomenological study, the researcher conversed with ten nurses (from hospice, long-term care, and acute care settings) and two family members who shared their experiences of caring for a dying patient or loved one who had air hunger. One patient's description of having air hunger before she died provided additional text. Conversations were transcribed verbatim and the texts were analyzed for themes. Themes that emerged from textual analysis include how the patient looked, which depicts panicked patients breathing rapidly with "eyes wild," beckoning the nurse to respond. This panicked look initiated a vicious cycling of air hunger that escalated the patient's breathlessness, panic, and anxiety. Witnesses to air-hungry patients described the embodied responses evoked--they, too, became short of breath. Responses of patients, family members, and nurses to air hunger involved the expiration of control. Within this theme, connections between culturally embodied breath, mind and body, and lessons in losing control are described in relation to caring for dying patients. The final theme, fine tuning death, describes the minutiae of ways nurses protect the dying process by minimizing suffering and easing the passage to death. Nurses must know what to do for air-hungry patients. This doing and knowing is situated within a way of Being and staying present to patients and their family members. The goal of this inquiry was to describe and understand the phenomenon of caring for dying individuals who have air hunger. Implications of this research expand outward from its focus, like the rippling effect of a pebble dropped into a pond: it has relevance to how death is approached in this society, how caregivers respond to suffering individuals, and how each patient's care is situated within a context of family and culture.