Nurses perform a vital role in the care of dying patients and their families. Hence, experiences of nurses are a meaningful source from which to advance holistic end-of-life care. In this study, a hermeneutic phenomenological perspective was used to explore the phenomenon of end-of-life nursing care. Details derived from a scientific exploration into the experiences of 13 registered nurses who provided care for patients and families at end-of-life in the inpatient hospital setting offer understandings regarding this important phenomenon. The hermeneutic phenomenological methods of Max van Manen guided data collection and analysis. Three main themes described the participants’ experience of nursing care at end-of-life: “Confronting Challenges,” “Coming to Understand End-of-Life Care,” and “Transforming the Understanding of End-of-Life Care into Nursing Practice.” Recommendations for nursing education, practice, and research were derived.

v anglickém jazyce: The aim of the thesis is to provide description of nursing and medical aspects and offer ethical and legal context concerning the issue of living will. The body of the thesis is divided into theoretical section and practical section. The theoretical section deals with the issue of living will from the nursing and medical point of view with characterization of several serious conditions in intensive care such as apalic syndrome, terminal state etc. The chapter on legal aspects of living will defines the term 'lege artis', 'do not resuscitate - DNR', and characterizes the matter of decision making in the case of serious and terminal states. The chapter on ethical perspective discusses the process of dying and the Christian point of view on the issue of dying. The practical section processes the results of a survey based on 104 non-professional respondents and their replies to a provided questionnaire. The research section analyzes the level of knowledge which non-professional population has of the issue of living will. The closing discussion evaluates the confirmation of established hypotheses and provides practical suggestions. Keywords: living will, dying, ethic, resuscitation, terminal state.

DIMENSIONS OF PAIN OF A DYING PERSON IN CONTEXT OF LIFE AND WORK OF CICELY SAUNDERS Pavel Beránek, Special Education, Department of Special Education, Faculty of Special Education, 2010 The thesis aims at Cicely Saunders (1918-2005), the founder of the modern hospic movement, at her influence on the movement and at the ideas she introduced. The personality of the dying person, listening to him/her and perception of his/her needs are described as key-stones of her thinking. The needs are seen through the concept of total pain - physical, psychical, social and spiritual. Special attention is given to influence of Viktor Frankl. Key words: Cicely Saunders, hospice, total pain, dying

The main topic of this dissertation is Volunteers in hospice care in the Czech Republic. The aim was find the role of volunteers in hospices and benefit of their work for clients of these institutions. The work is divided into six chapters. Theoretical part consists of five chapters focused on death and dying and of ethical issues of the end of life. The research and its results are described in sixth chapter. The overall goal of this dissertation is to talk about end of life dying and death because it is a taboo in our society.

Vývoj hospicové paliativní péče se zaměřením na Německo a Českou Republiku Development of hospice-palliative care with focus on Germany and the Czech Republic Ruth Kubíčková The aim of the thesis was to map the development, crucial moments and current .shape of hospice-palliative care and simultaneously confirm the thesis that the care of spiritual feature of dying persons has been an integral part of organized development of hospice care since its beginning and nowadays, it is still one of its principal themes. The first chapter deals with branch terminology since its clear definition is essential, not only for dialogue inside the system of palliative care providers and experts, but for interdisciplinary communication and cooperation which is - according to the definition of palliative care - the foundation of its holistic approach to patients. The second and third chapters are concerned with the development of nursing care since the ancient times to the diversification of modern hospice-palliative care at the end of the twentieth century. They deduce that the Christianity, with its central commandment to love thy neighbour as thyself, has changed the attitude to care of suffering persons, both in the nursing care and in shapes and ways of providing care. In the response to revolutionary changes in...

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.

The purpose of the Roman Argei ceremony, during which the Vestal Virgins harvested made and paraded rush puppets only to throw them into the Tiber, is widely debated. Modern historians supply three main reasons for the purpose of the Argei: an agrarian act, a scapegoat, and finally as an offering averting deceased spirits or Lares. I suggest that the ceremony also related to war and the spectacle of displaying war casualties. I compare the ancient Near East and Rome and connect the element of war and husbandry and claim that the Argei paralleled the sacred marriage. in addition to an agricultural and purification rite, these rituals may have served as sympathetic magic for pre- and inter-war periods. As of yet, no author has proposed the Argei as a ceremony related to war. By looking at the Argei holistically I open the door for a new direction of inquiry on the Argei ceremony, fertility cults in the Near East and in Rome, and on the execution of war criminals.The Argei and new year’s sacred marriage both occurred during the initiation of campaign and spring planting and harvest season. Both in the ancient Near East and in Rome, animal victims were sacrificed and displayed through impaling, crucifixion, and hanging for fertility and in war. for both Rome and the Near East war casualties were displayed on sacred trees. Through the Near East cultures a strong correlation existed between impaling, hanging, and crucifixion in war and Sacred Tree fertility worship. By examining Roman tree worship, military rituals, and agricultural ceremonies a similar correlation becomes apparent. on the same day of the Argei, Mars was married to the anthropomorphized new year and within the month became a scapegoat expelled from the city. Additionally, on the first day of the Argei boys became soldiers.

Apesar da diminuição dos índices de violência na última década, o número de mortes por causas externas, não naturais, ainda é muito elevado na cidade de São Paulo. Os mais atingidos são jovens do sexo masculino moradores das periferias. Nesta pesquisa foram entrevistados adolescentes que cumpriam medida socioeducativa em meio aberto em duas casas de Liberdade Assistida, nas periferias sul e norte da cidade. O objetivo foi verificar como os jovens em questão percebem o fenômeno da morte na adolescência, que causas e que soluções atribuem a ele. A abordagem foi qualitativa, tanto para a coleta quanto para o tratamento do material obtido. Em seus relatos, os colaboradores denunciam a exposição constante a situações de violência, risco de morte e perda de pessoas queridas em conflitos com a polícia ou assassinadas por vingança. Apontam como uma das principais causas da morte de jovens a falta de valor dado à vida. Como solução, recomendam a ampliação do número de vagas de emprego, a eliminação das armas de fogo, do tráfico de drogas, e a urbanização das favelas; ressaltam, assim, a importância da inclusão social e da valorização da vida. Este é um tema que demanda pesquisas para embasar políticas públicas que visem a minimizar o desperdício de vidas de adolescentes e estabelecer uma cultura de paz através da inclusão social. / Although the decreasing rates of violence in the last decade, the number of deaths by external, not natural, causes is still elevated in São Paulo. The most affected are male teenagers and young adults living at the edges of the city. In this research teenagers that were placed into socio-educational measure in freedom at two facilities for Accompany Freedom of southern and northern edges of the city were interviewed. The target was to verify how they observe the phenomenon of death during adolescence, its origins and causes, and solutions for it. The approach was qualitative, for both collecting and analyzing data. In their narrations, the interviewed teenagers denunciate constant exposure to violence situations, risk of death, and loss of their beloved ones during conflicts with police or murdered as vengeance. They point the lack of value of life as one of the main causes for those deaths. As solution, they recommend increasing the number of available jobs, eliminating fire guns, illegal drug trade, and restructuring shantytowns (favelas); thus, they remark the significance of social inclusion and worth of life. This subject demands more researches to ground public policies that aim minimizing the waste of teenager\'s lives, and establishing a culture of peace through social inclusion.

Although psychical research identified through structured research the commonality of anomalous experiences for the bereaved from as early as the 1880s, it wasn’t until the 1970s with the publication of a medical doctorate on such phenomena that medical communities and social science began to recognise them too. Beyond this point, research became more popular on the subject. Extensive research conducted on post-death experiences (aka, Post-Death Contacts – ADCs) since the 1970s, has largely focused on what impact they have on the bereaved, rather than the ontology of the phenomena themselves. All such studies have found these experiences to be therapeutic for the bereaved, and a natural aid to recovery. However, no research findings to this point have been presented on what cognitive mechanisms create the therapeutic gains experienced, as a direct result of the spontaneous anomalous experiences. This thesis set out to investigate what makes such experience therapeutic, and aid the process of recovery from grief. From a critical review of the previous literature, it was noted that several of the extensive studies, and related popular literature, identified hope to a consistent reported outcome of such experiences. However, no existing studies appeared to have investigated its presence and process in this context. Therefore, a mixed method study design was developed to investigate the impact of such experiences further and the role of hope within them. A questionnaire approach of validated scales found levels of hope to be significantly higher in groups of the bereaved who do report post-death experience than those who don’t. The bereaved who do not report such experiences appear to encounter a significant drop in hope. Content and thematic analyses were conducted on written feedback of experiences collected from the questionnaires; this highlighted the variety of experiences and their commonality. It also highlighted significant shifts in ‘states of mind’ from negative to positive emotions, from the point of loss, to following the first anomalous encounter. Continued bonds with the deceased were also expressed, as well as previously noted therapeutic gains and themes of hope. In-depth interviews were conducted as the final study of this thesis, with an interpretative phenomenological analysis applied to the data. New findings are presented on the personal changes that take place within post-death events. Experients defined hope and how they saw it acting within their lives and experiences as a support system to feelings of loss, which fell in line with previous positive psychology theories on hope. Several key points are concluded. Firstly, the findings of this thesis have practical applications to clinical practice surrounding palliative care and applied positive psychology, regarding the importance of anomalous experiences encountered by the bereaved. Secondly, the thesis and its findings demonstrate the multi-disciplinary approaches which can be taken to parapsychological issues, in this case combining positive psychology, thanatology and healthcare. And finally, the thesis highlights the usefulness of the mixed method approaches, to provide ‘sweeping maps’ of any given phenomena under investigation, particularly in cases where the previous research findings are limited or are yet to be explored.

As inquietações por estudar esta temática apreendendo quais significados atribuem os enfermeiros ao cuidar do paciente idoso, hospitalizado, em fase terminal, surgiu a partir de experiências pessoais. Minha inquietação aumentou com a prática profissional, notando que, o pessoal que atendia aos idosos, em fase terminal, em sua maioria, era auxiliar de enfermagem, sem nenhuma formação específca para este cuidado. Assim, ao surgir a oportunidade de ingressar no doutorado em enfermagem, emergiu, novamente, a inquietação que há muitos anos vinha se instalando: O quê significa para a enfermeira o cuidado do idoso, em seu encontro com a morte, no mundo hospitalar? Desta forma, a proposta foi possibilitar que suas experiências, manifestadas por meio do discurso verbal e não verbal, pudessem aproximar-me do mundo que elas habitam nos hospitais e saber quais significados atribuem a esta experiência para propor um novo pensar sobre este cuidado. Tratou-se de um estudo conduzido segundo uma abordagem qualitativa, pertinente às questões muito particulares de um objeto cuja natureza não pode ser quantificada. A investigação foi desenvolvida com enfermeiros que trabalham nos hospitais públicos, na cidade de Celaya, Guanajuato, pelo fato de atenderem à maioria da população idosa. A coleta de dados foi realizada por meio de 12 entrevistas, conduzidas segundo a abordagem fenomenológica, a partir de uma questão norteadora proposta aos enfermeiros. Durante a investigação, pude apreender que, para eles, a vivência do cuidado do paciente, enquanto profissionais de enfermagem, envolve vários aspectos como as especificidades da pessoa da qual se cuida, como suas características físicas, emocionais, sociais e espirituais. Foi descrito ainda como sendo o ato de ajudar o paciente a morrer. No entanto, muitas vezes, procuram realizá-lo de forma a protelar a morte, como um impulso para conservar a vida daquele que está morrendo. Esse cuidado é proporcionado em um mundo concreto - geralmente, o hospital - e é um desafio manifestado pelos enfermeiros de forma a permitir o respeito às decisões do paciente e de sua família. Da mesma forma, as políticas das instituições de saúde pública necessitam serem revistas para que o familiar possa permanecer próximo do idoso em fase terminal, pois é seu direito morrer em companhia dos seus, de forma a ter uma morte digna. Reconhece-se, cada vez mais, que este cuidado é uma especialidade de enfermagem que requer conhecimentos e capacidades profissionais específicos e uma determinada estrutura de carreira profissional. / The restlessness for studying this theme, and learn about the meanings that nurses assign to caring for dying older patients, aroused from personal experiences. My restlessness increased with professional practice, and I noticed that the majority of the staff who cared for older, terminal patients were auxiliary nurses, with no specific training for this particular health care practice. Hence, when I ran across the opportunity to enter the nursing doctorate program, this restlessness, which had been present for many years, emerged once again: What does it mean, for nurses, to care for older individuals, as they face death, in the hospital environment? Therefore, the purpose was to permit that their experiences, reported both verbally and non-verbally, could bring me closer to the world they inhabit in the hospitals, and learn about the meanings that they assign to this experience. That way, I would be able to propose a new thought concerning this care. This study used a qualitative approach, pertinent to the very specific issues of an object whose nature cannot be quantified. The research was developed with nurses working in public hospitals in the city of Celaya, Guanajuato, because they care for the majority of the elderly population. Data collection occurred through 12 interviews, conducted according to the phenomenological approach, based on a guiding question directed to nurses. During the research, I learned that, for the nurses, the experience of caring for the patients involves various aspects like the specificities of the person being cared for, as well as his or her physical, emotional, social, and spiritual characteristics. Nurses also reported that their work was the act of helping the patient to die. However, nurses often seek to, through their work, postpone death, as an impulse to preserve the life of who is dying. This care is provided in a concrete world - usually the hospital - and nurses state that it is a challenge to respect patients\' and their family\'s decisions. Similarly, public health institution policies should be reviewed so as to permit relatives to stay close to terminal patients, since it is their right to die in the company of their loved ones, as a way of having a dignified death. It has been more and more recognized that his care is a nursing specialty that requires specific professional knowledge and skills, besides a particular professional career structure.