This dissertation examines end-of-life experiences at a small Zen hospice in the Pacific Northwest region of the United States. Through an exploration of how end-of-life communication, sense-making, decision-making, and care in this setting differ from that of typical clinical settings, this project highlights and interrogates the experiences of dying as spiritually, rhetorically, narratively, relationally, and communally bound events. Keywords: Zen hospice, end of life, narrative sensemaking, medical-ethical decision making, spirituality, healing rhetoric, communities of practice

Bakgrund: Varje år dör cirka 95 000 personer i Sverige, de flesta dör efter en längre tids sjukdom och vårdas sin sista tid i livet på särskilt boende eller i det egna hemmet. Sjuksköterskan kommer att stöta på dödsfall i olika situationer under hela sitt yrkesverksamma liv. Sjuksköterskor tillhör en yrkesgrupp som löper stor risk att konfronteras med känsloladdade möten och extrema situationer Kunskap om vad som påverkar sjuksköterskor och hur de förhåller sig till döden och döendet kan främja en mer öppen och medveten attityd i vårdarbetet. Syfte: Att belysa hur sjuksköterskor förhåller sig till döden och döendet i vården, samt vad som påverkar dem i deras förhållningssätt. Metod: Allmän litteraturstudie genom databassökningar. Resultat: Sjuksköterskor förhåller sig till döden som värdig eller ovärdig. Erfarenhet och tid påverkar sjuksköterskors förhållningssätt i vårdarbetet. Känslomässig balans mellan närhet och distans var viktigt för sjuksköterskorna och deras förhållningssätt till döendet och döden påverkades av existentiella frågor och acceptans. Ett empatiskt förhållningssätt eftersträvades. Sjuksköterskor bearbetar händelser och reflekterar framförallt med hjälp av informellt stöd. Konklusion: Sjuksköterskor förhåller sig till döden och döendet olika, de använder sig av medvetna och omedvetna bemästringsstrategier, så kallad problemfokuserad och emotionsfokuserad coping. / Background: Every year, around 95 000 people die in Sweden. Most die after a prolonged illness, and care for their last time in the life in specific residential or in their own home. Nurses will encounter death in various situations throughout their working lives. Nurses pertains a professional group which extend a big risk with emotional confrontation and extreme situations. Knowledge about what effect them and how they approach death and dying, can improve a more open and aware attitude in the nursing care. Aim: To illuminate nurses attitude toward death and dying in care, as well as what affect them in their approach. Method: General literature review by database searches. Result: Nurses approach death as worthy or unworthy. Experience and time affect nurses' attitude in health care work. Emotional balance between proximity and distance was important, the existential questions and acceptance affected nurses in their idea of dying and death. They pursue an emphatic approach. Nurses processes events and reflect mainly using informal support. Conclusion: Nurses has different attitude towards death and dying, they use conscious and unconscious compensation strategies, also known as problem-solving and emotions-solving coping.

Americans often face end-of-life with ineffective pain/symptom control. While hospice care prevents suffering for the terminally ill, only around 40% of individuals access services. Although few studies describe differences in terms of cancer vs. non- cancer diagnoses, hospice utilization/access disparities appear to exist. Analyzing 14 sociodemographic and clinical variables for 3,905 hospice discharge cases, this study highlights observed disproportions between cancer and non-cancer groups, identifying significant relationships amongst patient characteristics and hospice diagnosis. Factors found significantly related to diagnosis include components of the following: age, primary payment source, mortality status at discharge, hospice initiation location, length of stay, physical function, cognitive function, and presence of pain symptoms. Results confirm low overall hospice utilization rates, while validating diagnosis-specific differences driven by individual and population-based characteristics. In order to increase utilization/access rates and eliminate current disparities, patients presenting with certain terminal diseases may require greater provider flexibility in terms of hospice eligibility requirements.

Abstract Cancer is one of the main public health problems in the world. People diagnosed with cancer may become depressed and fearful of dying. This causes them to question treatments and sometimes avoid treatment altogether. Cancer may change the person's life and the lives of others around them. The current study focused on the psychosocial impact of impending death for cancer patients in Saudi Arabia. Currently, the relationship between the death anxiety and death depression in persons with cancer in Saudi Arabia is not yet clear. Added to that, little research has been conducted with Muslim cancer patients and their emotional needs. This study explored the relationship between death anxiety and death depression among cancer patients in Saudi Arabia. The study sample consisted of 100 Saudi cancer patients, 50 male and 50 female, ranging in age from 18 to 85 with a mean age of 45.5. All participants completed a survey questionnaire that included three parts: the first part contained a demographic data form; the second part consisted of 20 statements to measure death anxiety using the Arabic Death Anxiety Scale; the third part was a 21-item, questionnaire designed to measure depression about impending death using the Death Depression scale-Revised Arabic version. The results of this study revealed statistically significant correlation between death anxiety and death depression (r= .85, p In addition, in Saudi Arabia health care providers target cancer symptoms and barely address the psychosocial issues. This may be due to a lack of communication between patients and health care providers. On the other hand, providers lack the time to spend with patients and have to treat to great number of patients. Therefore, the results of this study suggest that the health care providers should spend some time with each patient discussing feelings with no boundaries, and try to understand the patients' feelings, and involve them in decision making Death depression and death anxiety are universal feelings and should not be neglected. Consequently, this research may expand the knowledge base about death anxiety and death depression in Saudi Arabia that might lead to intervention that would help to improve patients' quality of life.

Although the curative model of medical care is predominant it is necessary to consider the palliative strategies at the end-of-life. The inter-relation of dying children, their families and pediatric palliative care teams are seldom analyzed outside Palliative Care. However, it is important to ethnographically think about the disturbing experiences of body and subject disintegration while people are directly experiencing them, even when the person is a child or a newborn baby. A central topic in this study is how personhood, body formation and disintegration, and childhood can be understood within the context of unevenly constructed and shared palliative communication with and without words. Hence, I analyze in this study how a Palliative Care Team in the city of Buenos Aires provides care, communicates, and ultimately produces a particular companionship to dying children and their families. This work is built on qualitative information gathered and produced during my four-month fieldwork with the Palliative Care Team. The ethnographic techniques (participant observation, non-participant observation and open-ended semi-structured interviews) I conducted show that their strategies of care and communication have as the main goal the process of companionship at the end of children’s lives. It is necessary to understand how patients, parents, and other family members are situated in this field of tensions between restorative and palliative medicine, and brought into this culture of Palliative Care in a public children’s hospital. My research asks, in what ways are pediatric Palliative Care practices exclusive to the social and cultural contexts of Buenos Aires? This work has three main sections: 1. care, 2. communication, and 3. companionship. In section one I focus on the clinical and non-clinical aspects of care involving the professionals’ and volunteers’ practices of giving care. In section two I concentrate my attention on the verbal and non-verbal aspects of the Palliative Care Team communication with children and families. In section three I consider the professional production of ‘companionship’. In this thesis I will demonstrate the significance of this concept according to the Palliative Care Team members and how care and communication are the base for the ‘production of companionship.’

There is a question: what can happen to person in the society, which tends to ignore or to avoid death? What kind of factors increase (and do they increase) concern felt about death? What should be constantly changing medicine like: a human, respectable job or a new kind of science, which does not pay attention to person and does not try reduce his pains, but to prolong his life? Purpose of this final master work – to estimate the view of a dying person of the students of the Nursing faculty. Tasks of the research: · to estimate the studies’ view of the most frequent physiological, psychological, social, spiritual problems of a dying patient in the palliative care; · to compare the differences of the view of a dying person between the students of the Nursing faculty of KMU of different study programs in the first and the fourth course; · to estimate the need of the knowledge about a dying person in the students’ opinion; · to prepare a booklet about dying people’s conception for the students. The agreement of the bioethical Committee of KMU was received to do this research, the research was confidential. 125 students of the 1st and 4th course of the Nursing faculty of KMU were researched. They were given the questionnaire with question about palliative care and problems of bad ill and dying patients. The received results were estimated by using of a statistical analysis. After analyzing the received answers the view of the main care problems of dying people was estimated. The... [to full text]

Even if the treatment of cancer has developed over the last decades 50% of the patients still die of their cancer. The doctor's way of dealing with his and his patient's anxiety must surely be of significance for the treatment the patient receives. In the first part of the thesis earlier studies of physicians' stress and ways of coping are reported. There is a lack of systematic studies which show how doctors working with cancer patients adjust to this work. The aim of this investigation is to study cancer doctors' difficulties and coping strategies. The theoretical frame of the study embraces parts of psychoanalytical theory and coping models, emphasizing that both unconscious and conscious psychological processes play their part in the coping process. The second, empirical part of the study includes 23 physicians strategically selected out of a population of physicians who work with institutional care and who have daily contact with adult cancer patients. The main method of data collection has been a series of recorded interviews. The focus of the interview was the physician's perception of how he reacts, thinks, talks and acts in different phases of the cancer disease. To illustrate the defence strategies of the interviewers, the projective percept-genetic test, the "Defence Mechanism Test" (DMT) is used. The "Structural Analysis of Social Behaviour" (SASB) has been used to study the doctors' self image. The results indicate that the stated difficulties deeply affect the doctor as a human being. The statements reflect conflicting feelings and wishes in relation to authority, conflicting feelings and wishes in relation to frightening and injuring, conflicting feelings and wishes in relation to intimacy/distance. Thirty themes of coping strategies frequently recur and they have been grouped into seven categories. Most of the doctors "seek knowledge" and support from scientific literature. The majority of them state that attempting to "solve a problem" is their main strategy. Most of the doctors "seek support " as a part of their coping strategy. An interesting observation is that the doctors to a higher extent "seek a relation" to their patients rather than to their colleagues. Almost one third use "denial of the severity of a situation" as their main strategy. All the doctors consciously or unconsciously use "diverting strategies", i.e. undertake tasks which are devoid of contact with patients, such as research and administration or other activities which allow them to avoid the patient. One third use "projective manoeuvres" but this is never a main strategy. In the third part of the study the credibility of the results and their pedagogical and practical implications are discussed. / <p>Diss. Umeå : Umeå universitet, 1994</p> / digitalisering@umu

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Although the curative model of medical care is predominant it is necessary to consider the palliative strategies at the end-of-life. The inter-relation of dying children, their families and pediatric palliative care teams are seldom analyzed outside Palliative Care. However, it is important to ethnographically think about the disturbing experiences of body and subject disintegration while people are directly experiencing them, even when the person is a child or a newborn baby. A central topic in this study is how personhood, body formation and disintegration, and childhood can be understood within the context of unevenly constructed and shared palliative communication with and without words. Hence, I analyze in this study how a Palliative Care Team in the city of Buenos Aires provides care, communicates, and ultimately produces a particular companionship to dying children and their families. This work is built on qualitative information gathered and produced during my four-month fieldwork with the Palliative Care Team. The ethnographic techniques (participant observation, non-participant observation and open-ended semi-structured interviews) I conducted show that their strategies of care and communication have as the main goal the process of companionship at the end of children’s lives. It is necessary to understand how patients, parents, and other family members are situated in this field of tensions between restorative and palliative medicine, and brought into this culture of Palliative Care in a public children’s hospital. My research asks, in what ways are pediatric Palliative Care practices exclusive to the social and cultural contexts of Buenos Aires? This work has three main sections: 1. care, 2. communication, and 3. companionship. In section one I focus on the clinical and non-clinical aspects of care involving the professionals’ and volunteers’ practices of giving care. In section two I concentrate my attention on the verbal and non-verbal aspects of the Palliative Care Team communication with children and families. In section three I consider the professional production of ‘companionship’. In this thesis I will demonstrate the significance of this concept according to the Palliative Care Team members and how care and communication are the base for the ‘production of companionship.’

Dissertation (Ph.D.)--Auburn University, 2006. / Abstract. Vita. Includes bibliographic references.