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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>

Šiame magistro darbe: Pirmojoje dalyje atskleidžiamas krikščionybės požiūris į mirtį pagal Senąjį bei Naująjį Testamentus bei pagal naujausius Bažnyčios dokumentus. Aptariama kaip šis požiūris turėtų atsispindėti laidotuvių kontekste. Antrojoje darbo dalyje analizuojamas tradicinės bažnytinės laidotuvių apeiginės praktikos pagal Katalikų Bažnyčios dokumentus, apžvelgiami liaudies pamaldumo papročiai Lietuvoje nuo senųjų laikų iki mūsų dienų. Šioje dalyje taip pat tiriamos ir apibendrinamos laidotuvių tradicijos Vilniaus Šv. Pranciškaus Asyžiečio ir Švč. Mergelės Marijos Nekaltojo Prasidėjimo parapijose. Trečiojoje dalyje gvildenami krikščioniškosios mirties sampratos ir laidotuvių papročių panaudojimo ugdymo procese klausimai. Šioje darbo dalyje analizuojamos Bendrosios Katalikų tikybos programos mokyklai ir parapinės katechezės programos, pateikiamos kai kurios įžvalgos bei rekomendacijos, kaip kančios, mirties, laidotuvių, Vėlinių, amžinybės klausimus teikti katechezėje arba per tikybos pamokas. / The paper studies catholic funeral traditions in Lithuania in the light of the Scripture and of the teaching of the Church. The aim of the research is to show both the positive and the negative tendencies of popular piety in this respect and to define their educational meaning. The first part of the paper is devoted to a thotough analysis of Christian attitude towards death and dying. It provides references to the Old and New Testamentes, as well as to the newest Church documents. The second part provides the historical description of funeral traditions in Lithuania. It discusses their origin and their changes through the centuries. This part also includes a research on present funeral traditions as seen from the answers of twenty respondents from two parishes of Vilnius. The third part of the paper investigates into the school syllabi and parish catechesis programs. The task of this investigation is to see if the Christian attitude towards death and burial is property taught to children and adolescents. This part ends with several cathecetical recommendations. The paper concludes that funeral traditios in Lithuania especially in towns, are gradually losing their spirituality. Therefore, children and young people should be tought more opently about death and eternal life. Parish communities should pay more attention to preserving what is holy and sincere what can stimulate Christian hope, faith relationships and prayer. I have determined the correlations and disparities of... [to full text]

The creative nonfiction essays and poetry in this collection explore family survival during the hardest of times--when the desire to give up is at its greatest--as told from the perspective of a woman who is a daughter, sister, wife, mother, and grandmother. These are not stories of defeat. Nor are they merely explorations of death and dying. They are cleebrations of living, of surviving, of loving and being loved against all odds.

Background: Long-term care nurses are in a pivotal position to be augmenting the quality of life for residents and improving the death and dying experience for residents, their family members and surrogate decision makers. Currently there is a paucity of literature that acknowledges the experiences of long-term care nurses and their involvement with end-of-life decision making and care. Purpose: To describe long-term care nurses’ perceptions of factors that influence their communication with end-of-life surrogate decision makers and the kind of support they need to support this discussion. Method: A descriptive study using mixed-methods convergent design was used to obtain responses from a sample of 30 long-term care nurses. An online survey included questions to obtain quantitative data and open-ended questions for short responses. Results from both sets of data were brought together and compared during the analysis phase. Results: The findings of this study highlight the personal factors of the nurse, the characteristics of the surrogate decision maker, contextual factors, situational related inputs, and the support desired by long-term care nurses. Participants rated factors according to importance in their experiences of communicating with surrogate decision makers. Seven themes were inductively derived from the analysis: 1) selected or appointed as surrogate makes a difference, 2) strong trusting bond between nurse-resident and nurse-family, 3) being too close to see resident’s wishes, 4) interdisciplinary team agreement, 5) living will as a communication roadmap, 6) peaceful environment, and 7) the need to create emotional distance. Long-term care nurses also identified the types of support they seek or need to be effective in communicating with end-of-life care surrogate decision makers. Conclusion: As the numbers of the older population continue to increase, the demand for nurses to develop expertise in caring for dying residents and communicating with them, their family members, and surrogate decision makers will increase. Understanding their experiences and providing support to long-term care nurses may strengthen their capacity to communicate about death and dying and their delivery of quality end-of-life care to residents.

Sendo a violência e a preocupação com a segurança temas amplamente discutidos atualmente, seja por meio da imprensa ou de produção científica, a atuação profissional de policiais militares torna-se fator de preocupação e estudo, quer no âmbito da prevenção e repressão aos crimes, quer pelos desdobramentos que suas ações são capazes de provocar. Dentro deste contexto, de violência e risco, o presente estudo pretende traçar algumas considerações acerca da atuação do policial militar, que desempenha suas funções em ocorrências de alto risco, tendo como objetivo realizar um levantamento da produção científica com temática relacionada à atividade do policial militar, bem como verificar e detalhar a incidência de estudos cujo tema relaciona-se ao trabalho do policial como precipitador de sofrimento psíquico e implicações na saúde mental do trabalhador. A partir dos dados obtidos, foram feitas considerações a respeito do panorama geral das pesquisas que tem os policiais militares como sujeitos, bem como dos temas prevalecentes na produção científica nacional. Pôde-se constatar que, apesar do significativo aumento na produção científica nacional relacionada ao tema a partir do ano 2000, o que converge com a crescente preocupação a respeito da temática da violência como questão de saúde pública, quando se analisa a produção científica formal e acessível à comunidade acadêmica (em bases de dados comuns às pesquisas de nível universitário), os resultados ainda são diminutos se comparados à relevância do tema. Levanta-se como hipótese para tal fato a dificuldade em coletar dados qualitativos no âmbito policial, dadas as questões de hierarquia e protocolos pertinentes à organização da polícia como instituição, bem como certa resistência, calcada em estereótipos relativos à polícia como um todo, em enxergar o profissional de segurança pública como um cidadão, tão frágil e suscetível ao sofrimento quanto qualquer outro. / Once subjects like violence and worry about security are widely discussed nowadays, either by the press or scientific production, the knowledge about the military policemen activity become a very important factor, in the scope of prevention and criminal repression, or by the implication that their actions can cause. Within this context, the current study intends to make some considerations about the policeman activity, who very often works in very dangerous situations, making a scientific production survey, emphasizing the public security professional\'s activity. The purpose of this study was to check the incidence of works whose subject has to do with the policeman profession as responsible for the psychic suffering, as well as the implication in the worker\'s mental health. From the data obtained, we made considerations regarding the general view of the researches that have the military policemen as subjects, as well as the predominant topics in the national scientific production. We noticed that, in spite of the meaningful increase in the scientific production related to the subject from the year 2000, which is in accordance to the increasing worry about the violence as a matter of public health, when we analyze the formal and accessible scientific production to the academic community (in common databases regarding the university researches), the results referring to the qualitative researches are still small if we compare them to the subject relevance. We discuss the institutional and emotional factors which can be established as complicators at the time we gather the qualitative data among policemen, as well as the difficulty to see the public security professional as a citizen, so weak and susceptible to the suffering as any other.

This study focuses on how terminal diagnoses impact individuals and families within the Hispanic/Latino community. Hispanic/Latino hospice caregivers, Hispanic/Latino non-hospice caregivers and physicians participated in the study, which explores the utilization of hospice by Hispanic/Latino terminally ill individuals. The data collected from 30 semi-structured interviews, ethnographic participant observations, and archival data were analyzed using structured and statistical analysis. Verbatim transcripts were examined through a combination of ethnographic and content analysis. Barriers related to language and culture, as well as immigration, are critical themes that impact access to healthcare. The physicians' discourses relate patients' responses to terminal diagnoses, including the Hispanic/Latino patients' perceptions of hospice services. My research also ascertains how caregivers of Hispanic/Latino hospice patients cope with their loved ones' terminal diagnoses, structural organizational barriers to hospice utilization as well as cultural factors that contribute to the under-utilization of hospice services by this population. The findings indicate that higher incomes, higher education, and fewer years in the United States mainland directly affect healthcare decisions and treatment choices at end of life. Female gender and identity also directly impact access to health care, especially hospice services, at the end of life.

This paper reviews literature on the topic of death anxiety and therapy. The author conducted a study examining potential clients' perceptions of two different therapeutic approaches for working with terminally ill clients with death anxiety. A review of literature relevant to this topic indicates that death anxiety is correlated with many psychological problems; however, there are no clinical studies focused primarily on the treatment of death anxiety among clients with a terminal illness. In this study, potential clients were randomly assigned to watched either a short video of a cognitive behavioral therapy session or a short video of an acceptance and commitment therapy session focused on treating a terminal ill person's death anxiety. After watching the video, potential clients rated the session impact of the therapy approach using the Session Evaluation Questionnaire. In addition, participant's views of seeking psychotherapy were assessed with the Attitudes Toward Seeking Professional Psychology Help measure. No differences in ratings of session impact were found between participants who viewed the cognitive behavioral therapy session and the acceptance and commitment therapy session. However, participants' attitudes toward seeking therapy were positively associated with their views of the therapist and session depth. Consistent with past literature, women reported more death anxiety than men. In regards to potential clients' views of session impact variables, their view of postsession positivity was positively related to their view of session smoothness. Additionally, a positive correlation was found between potential clients' views of the therapist and session depth. Implications and conclusions are discussed.

This dissertation will support full ethical endorsement of terminal sedation for those most urgently in crisis and need of beneficence, those who are dying and in the final hours or days and suffering. To clarify the practice I first detail ethical differences between euthanasia, physician assisted suicide and terminal sedation. Moreover, I identify new areas where harms and benefits need to be evaluated as affecting not only patients, but also families and caregivers. I evaluate the current practice to allow the development of ethical guidelines and greater consensus on deciding the hard cases. This work may also serve to assist those looking to enlarge the practice in the future with ETS for those with debilitating diseases or disability, but they are not my primary goal. Below is the standard I propose for moral allowability for the use of terminal sedation. I will refer to it often in the pages that follow simply as my standard . Terminal sedation is the appropriate and intentional use of medications (benzodiazepines and/or narcotics) to produce ongoing, deep unconsciousness upon 1) a terminal patient’s (or surrogates) request due to 2) suffering intractable pain or other distressing clinical symptoms intolerable to the patient when 3) death is expected within hours or days (less than two weeks) due to the terminal illness, injury, or disease. I offer two versions of initial guidelines for development of hospital policy. The first version outlines minimal guidelines that ought to be utilized to allow TS for patients who fit my standard. The minimal guideline is based upon the recommendations of the American Medical Association with some modifications. The guideline is admittedly restrictive in hopes of gaining wider societal support for a currently controversial practice. Secondly, I offer more moderate guidelines for policy that could become a standard in the future. It maintains the restrictive focus of the minimal guidelines and offers additional education and support to others which has yet to be broadly provided. The moderate guidelines would mark an important step forward for allowing more choices in dying and offering additional supports to those involved with dying patients.

The overall aim of this thesis is to illuminate and describe bodily changes and problems in incurable cancer, with focus on prostate cancer, from the patient’s perspective. The thesis consists of four papers, each of which illuminates various aspects of the phenomenon studied. The study population consisted of 24 participants, three women with different cancer diagnoses in the palliative phase, and 21 men with hormone refractory prostate cancer (HRPC) and skeletal metastases. Data are based on interviews (papers I–IV) and a quality of life questionnaire (paper I). The study design is cross-sectional (papers I–III) and longitudinal (paper IV). Qualitative description, descriptive statistics, phenomenological hermeneutics, and analysis of discourse were used to analyze data. The findings of study I show that the dominating symptoms for the men with HRPC (n=20) were pain and fatigue, and three different variants of each problem were described. The men said that changes in their sex life were not an extensive problem, even if it was scored as such. The symptoms differed in occurrence, extent, and meaning between the men, and were not necessarily experienced as problems. In study II, pain and fatigue were again the most prominent problems in men with HRPC (n=18), but pain and fatigue were seen to have different meanings. Pain was seen as synonymous with cancer. Pain can be alleviated, but it is a threat, both now and in the future, and symbolizes a painful death. Fatigue was viewed as a hindrance in the present. It was experienced as less threatening than pain, but as something that cannot really be changed. Fatigue represents the natural course death will take, as eventually sleep into death. An important finding of study II is that one meaning of bodily problems is to live in a cyclical movement of losing and reclaiming wellness. Understanding, and, to some extent, being in control of, bodily problems makes it possible to experience wellness. When the bodily problems increase or change, or when new problems appear or become a hindrance in the daily life, the experience of being ill returns. The findings of study III show that one meaning of fatigue in patients with cancer in the palliative phase (n=4) is a lived bodily experience of approaching death. This can be understood through the paradox of struggling against fatigue, and hoping to overcome it, yet expecting failure. The body, through fatigue, signals to the person that death is approaching, but the person is not yet “ready”. Paper IV shows that the way two of the men with HRPC talked about the past, present, and future changed during the disease trajectory. In the first interview, the men were open towards both the past and the future, while just before death, their narration was totally dominated by the concrete experience of the illness. The past became the past in the illness and not in life, and the present was flooded with extensive bodily changes. Also, the future had shrunk, although it also had been transferred to beyond death. Pain, fatigue, nausea, and other bodily problems figured largely in this change. This thesis provides important insights into the phenomenon of bodily changes when living with incurable cancer, with focus on prostate cancer. The thesis shows the connection between bodily changes and time, where different bodily changes have different meanings, and meanings seem to change during the illness trajectory (papers I–IV); and bodily changes close to death seem to take “all” time; what is left is the present filled with problems (paper IV). Further, it shows that bodily changes have a great influence on the cyclical movement between losing and reclaiming wellness in incurable cancer (paper II). The clinical implications of the thesis are that alleviation of pain and other bodily problems must be based on the meaning the patient gives the bodily changes taking place. That is, alleviation with the purpose to free time and to facilitate living in wellness as death is approaching.