This review article addresses end-of-life care issues characterizing human immunodeficiency virus progression by delineating associated stages of medical and nursing care. The initial progression from primary medical and nursing care aimed at functional cure to palliative care is discussed. This transition is considered in accord with the major symptoms experienced, including fatigue, pain, insomnia; decreased libido, hypogonadism, memory, and concentration; depression; and distorted body image. From the stage of palliative care, progression is delineated onward through the stages of hospice care, death and dying, and the subsequent bereavement process.

Healthcare teams can implement care initiatives to promote a positive dying experience. However, there is a lack of knowledge related to how best to care for dying patients. Nurses do not receive extensive training in nursing school to care for patients at the end of life, yet most, at some point in their careers, experience the provision of this type of care. It is important to ensure that nurses caring for dying patients have been educated about end-of-life care. The purpose of the quality improvement project was to address the lack of end-of-life care education among critical care nurses in an acute care hospital by implementing and testing the effectiveness of an end-of-life care educational program. Kolcaba's theory of comfort was chosen as the theoretical framework for the project. Registered nurses (n = 34) employed on a critical care unit participated in the one-group pretest/posttest design project. The nurses completed the Healthstream online end-of-life care education, and knowledge improvement was determined through comparison of pretest and posttest scores. Descriptive tests were completed to determine the mean score. The descriptive data analysis and tests showed that participants' level of end-of-life care knowledge improved after they completed the formalized educational program. Participants' scores increased from pretest (68% to 100% correct answers) to posttest (93% to 100% correct answers). The primary populations benefiting from the project are nurses, dying patients, and family members of dying patients. The social change implication of the findings is that if nurses receive education on end-of-life nursing, increased knowledge of appropriate care for dying patients is expected.

Bereavement beliefs and practices in the modern, American culture have been well documented. However, virtually no research has been conducted on traditional and contemporary death, dying, grief, and bereavement beliefs and practices among native tribes, such as the Lakota. The present study was conducted with the Lakota, and fulfilled two goals. iii First, the contemporary and traditional death, dying, grief, and bereavement beliefs and practices of the Lakota were documented and summarized. Such documentation may help bereaved Lakota tribal members who are experiencing problems with death and bereavement, and may help preserve traditional knowledge, beliefs, and practices. Second, the consensus of opinion among Lakota tribal elders about death, dying , grief, and bereavement practices and beliefs was qualitatively evaluated and compared with that of mental health and substance abuse workers who serve the Lakota. Two main theoretical conclusions to this study were reported. First, the Lakota elders' preferred interventions for bereavement for their people included family, social, community, tribal , and ceremonial activities. These findings likely resulted from the functional aspects of these types of culturally appropriate practices not only to help the bereaved Lakota individual, but also to help "fill the hole in the circle" left by the death of a tribal member. A cultural mechanism for continued tribal unity and wholeness is provided by these tribal bereavement practices. Second, the ancient historical Lakota ceremonies used to ameliorate grief within the tribe appear to have been fragmented over time, but these rituals still exist and their derivatives are used in various contemporary forms. Two main clinical findings were reported. First, a careful clinical assessment of the bereaved Lakota client's level of acculturation is required as a prerequisite to treatment planning. Second, intervention with grieving Lakota clients should include informed attention to both "western" bereavement treatment methods and traditional Lakota family, community, and social bereavement practices. The relative value of various Lakota family, social, community, and tribal bereavement practices and a rank ordering of various Lakota ceremonies were provided. These ceremonies and Lakota tribal practices were compared to modern "western" bereavement treatment methods.

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In this dissertation I explore the cultures of death and dying in medical institutions, hospices and funeral work. I argue that not only are there competing cultures of death and dying in American society, but within these institutions that produce tension and conflict, sometimes among the workers, other times between the workers and those they serve, and other times between the institution and outside organizations. Medical institutions, by medicalizing death and dying, constructed a "death as enemy" orientation in which doctors fight death with the use of medical technology, practice detached concern from their patients, and marginalize religion and spirituality. On the other hand, a "suffering as enemy" orientation has also emerged, primarily in the form of palliative medicine, in which needless suffering is considered worse than death, therefore life-saving technology is removed, doctors empathize with patients and families, and spirituality is incorporated. Hospice started as a social movement to change how dying patients were treated at the end of life, addressing patients' physical, spiritual and emotional pain. However, the bureaucratization of hospice, particularly the Medicare Hospice Benefit, has led to a compromise of the social movement's ideals and these competing orientations shape how hospice workers, particularly nurses and social workers, express frustrations with their work. Funeral directors assert their jurisdictional claims of the right to handle the corpse and assuage the grief of the bereaved, through embalming, informal grief counseling and the funeral performance, but funeral directors encounter resistance from large funeral corporations and the funeral societies. Large corporations centralize embalming, turning the corpse from a craft to a product, recruit other professionals to practice grief counseling, and sell standardized funeral packages. Funeral societies challenge the necessity of embalming, funeral directors' expertise in grief counseling, and focusing on the value of simple, dignified and affordable funerals. I conclude this dissertation by showing how orientations toward death and dying vary in American society and these institutions because of tension between experts who espouse a particular orientation and activists who resist the claims of the experts.

All nurses must be adequately prepared to care for individuals requesting Medical Assistance in Dying (MAiD) due to the practical, ethical, personal, and legal ramifications associated with MAiD. Nurses are both professionally and legally obligated to be knowledgeable and skilled in navigating the care of individuals requesting MAiD. This qualitative systematic review explored the knowledge and education needs identified by nurses regarding MAiD. This qualitative systematic review was conducted following the JBI methodology for systematic reviews of qualitative evidence, including critical appraisal, study selection, data extraction and data synthesis. Four themes were identified: 1) ethical and moral challenges, 2) legislation and standards, 3) communication, and 4) mandatory MAiD education. The information and practice recommendations found within this review can be used to support the knowledge and education needs of all nursing students and practicing nurses throughout Canada.

Medical Assistance in Dying (MAID) was legalized in Canada in 2016. In 2021, an update in legislation included changes to MAID eligibility and procedural safeguards. Guided by the Ottawa Decision Support Framework (ODSF), the overall aim was to describe how Canadian patients considering MAID are being supported in making the decision about end-of-life care. Eleven articles were included in the literature review. ODSF themes are evident in MAID literature. Nurses play key roles in end-of-life decision-making. Environmental scan of publicly available MAID resources identified 58 eligible resources. Sixty-nine percent of MAID resources were updated with 2021 legislation. None met the International Patient Decision Aid Standards criteria. Thirty met Patient Education Materials Assessment standard for adequate understandability and 11 for actionability. Although patient decision aids are effective for supporting health care decisions, none exist for MAID and current resources are inadequate for supporting people of lower health literacy.

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<p>Humans and domesticated animals have lived alongside one another for thousands of years, yet scholars have only recently begun to examine how companion animals, or pets, influence human lives (Knight, 2005). Today, 67 percent of United States households contain companion animals (APPA, 2019-2020) and many people consider their pets as family (Irvine & Cilia, 2017; McConnell et al., 2019). Given this, the death and dying period for pets can bring about distinctive concerns and difficulties within the family system, yet little is known about how individuals navigate the pet end-of-life period within the family, and how family communication manifests in this context. This study aimed to understand the interactional challenges for families communicating about the end-of-life period for their pets. Guided by family systems theory (FST) as an analytic framework, the goal was to better understand these dynamics using qualitative methods to address two main research questions. First, what are the challenges families face during the companion animal death and dying period? And second, how do families respond communicatively to these challenges? This qualitative study used a grounded theory approach to analyze 27 in-depth interviews with individuals who had experienced a death of their pet in the prior year and centered on how families described the place of their pets within the system. Of those participants, 14 individuals consisted of family dyads (51%) in various subgroups of partners, parent-child and siblings. Analysis affirmed some of what is known from the literature (such as feelings of guilt and financial worries associated with pet end-of-life) but also extended what is known by documenting family decision-making dilemmas, such as the dialectic tension between holding on and letting go, as well as noting the reverberations through the family of avoiding talk about death and disruptions to family communication after death. This manifested in primarily a decrease in talk about the pet or talk with family members (both in-person and mediated channels) or an increase in talk following the death. These findings suggest that pet death has the potential to disrupt a family's regular communication patterns.</p> <p>These findings affirmed that supportive communication after a death loss is important to individuals and particularly helpful from others with prior pet loss experience. Along with social support, participants indicated that the artifacts left behind after the death of their pet provided comfort and were also elements of tension and cohesion within the system. As scholars suggest, companion animals are liminal creatures, existing as kin and "other" within the family (Irvine & Cilia, 2017; Sayers et al. 2022). Indeed, participants described their pets as existing in a space at the edge of true family member whose fate was exclusively in the hands of the family, particularly in the context of euthanasia, which contributed to some of the communicative challenges identified. </p> <p>Given limitations of a mostly regional and homogenous sample and the conceptual limitation of extrapolating from two individuals in a family to the whole system, this study was still able to take the next step needed for understanding the communicative challenges faced by families in confronting pet death. Findings extend the concept of pet-as-family, in that pets were found to be an element of the "family tapestry" serving the role of both emotional support and kin for some family members. In that manner, they were also discovered as integral to the family timeline, a catalyst for connection between family members, and thus worthy of further study from a communication and family system perspective.</p>