This cross-disciplinary essay explores the use of John Green’s The Fault in Our Stars (2012) and its pedagogical implications for learners in middle school. It demonstrates that the novel expresses preparatory grief by implementing internal focalisation through the main character Hazel Grace. The essay also argues that the pedagogical implications related to the novel can yield fruitful results in the EFL classroom. The analysis is conducted by, firstly, exploring the novel’s depiction of preparatory grief and, secondly, examining the pedagogical implications from a trauma-informed teaching perspective. The main findings are that preparatory grief is present throughout the novel and that a trauma-informed teaching approach is apt for the inclusion of the novel in the EFL classroom, which ultimately can improve learners’ awareness of a young adult’s perspective on the process of dying.

“Mindfulness gets thrown around all the time, but what does it actually mean in practice?” I interpreted this question posed by a nurse in this inquiry, as a statement of curiosity and concern. As conceptualizations, practices, and programs of mindfulness continue to diversify, there is a call to understand mindfulness as a socially and culturally embedded practice. Some critiques suggest mindfulness is moving too far from its ethical orientation and becoming instrumentalized as a tool. Therefore, the pervasive presence of ‘mindfulness’ across work and educational settings renders the question what does mindfulness actually mean in practice? an important one for nursing as a discipline, and within palliative care nursing practice. Mindfulness is proposed broadly here as an approach to meet therapeutic and relational aims for nurses within palliative care practice. What it means to be mindfully present and compassionate in the midst of suffering, strong emotion and profound uncertainty is rarely discussed. Grounded in conversations with nine palliative care nurses (their words italicized), I explored how mindfulness shapes relationally engaged ways of being while caring for people with terminal disease and existential distress. Using a contemplative dialogical narrative approach, I analyzed nurses’ stories as units of data to explore multilayered narratives with personal, social, and cultural storylines. Using an emergent and iterative design, I dialogued across various aspects of the research process enacting an integrative approach. Metaphorically, this dissertation is structured as a contemplative walk within a classical seven-circuit labyrinth; readers are invited to walk a circuitous path while following along as stories take the lead. Seven turns in the labyrinth outline a path conveying key recursive narratives of mindfulness. Turning in various directions three guiding story threads are woven together to create the path: 1) palliative care nursing as mindfulness is an embodied ethic creating space(s) for creativity and ‘connection’ through the ‘big stuff’; 2) such ‘space’ can be generated and accessed through somatic practices of ‘self-awareness’ and ‘self-care’; and 3) spaces of caring are continuously transforming within the communities in which they are practiced. Nurses’ stories foreground ways organizational and educational systems support or constrain how mindfulness as an embodied ethic of care can be enacted. This study adds to the ongoing conversation of mindfulness and its value when practiced/understood as palliative care nursing. As the historical Buddha was quoted to have said “of all mindfulness meditation, that on death is supreme.”

Bakgrund: Döendet är naturlig del i livet som berör alla människor. Sjuksköterskor möter döende patienter i vården. Anhöriga beskriver att den döende närstående är i behov av information och närvaro från vårdpersonal. Ibland beskriver anhöriga att vårdpersonal brister i kommunikation och tillgänglighet i den döendes vård. Syfte: Att beskriva sjuksköterskors erfarenheter av att vårda döende patienter. Metod: Elva artiklar analyserades med kvalitativ metod genom systematisk litteraturstudie med beskrivande syntes. Resultat: Två teman och fem tillhörande subteman framkom. Temat Relationella utmaningar med tre subteman Att samspela med patienter, Att samspela med anhöriga och Att samspela i vårdteamet. Det framkom att det ibland var utmanande för sjuksköterskor att samspela med patienter, anhöriga och andra professioner. Temat Existentiella utmaningar synliggjorde två subteman Att vara närvarande och Att bli personligt påverkad. Det framkom att sjuksköterskor blev påverkade i vården av döende patienter och hade varierande sätt att bearbeta sina emotioner. Slutsats: Sjuksköterskornas samspel med döende patienter, anhöriga och vårdteamet var av betydelse för bemötande. Sjuksköterskornas närvaro främjade trygghet hos döende patienter. Sjuksköterskor blev ofta personligt påverkade av relationen till döende patienter och dess anhöriga som bearbetades genom exempelvis fysisk aktivitet. / Background: Dying is natural and affects all people; nurses will face dying in the care of patients. The relatives' perspective is that the dying person is in need of, among other things, information and the presence of healthcare staff. Relatives sometimes describe that care staff lack communication and accessibility in the dying person's care. Aim: To describe nurses' experiences of caring for dying patients. Method: Eleven articles were analyzed by a qualitative method through systematic literature study with descriptive synthesis. Results: Two themes and five associated sub-themes emerged. The theme Relationship Challenges, which provided three sub-themes: Interacting with patients, Interacting with relatives and Interacting in the care team. It was discovered that it was sometimes challenging for nurses to interact with patients, relatives and other professions. The theme Existential Challenges highlighted two sub-themes Being Present and Being Influenced. Analysis showed that nurses were influenced in the care of dying patients and had varying ways of processing their emotions. The presence of nurses created security for dying patients. Conclusion: The nurses' interaction with dying patients, relatives and the care team was important in meeting their varying needs. The presence of the nurses promoted the safety of dying patients. Nurses' risk of being personally affected by the relationship with dying patients. The personal impact was processed through, for example, physical activity.

Syftet med studien var att undersöka hur präster och diakoner genom sin yrkesutövning upplever att döende och sörjande människors reflekterar och känner kring döden. För att svara an på syftet användes en kvalitativ metod i form av en tematisk analys. Datainsamlingen gjordes genom sju intervjuer, där en semistrukturerad intervjuguide användes. Kriterierna för deltagarna var att ha en yrkesroll som präst eller diakon och att ha erfarenhet med döende och/eller sörjande människor. Den tematiska analysen genererade sju teman för att besvara de två frågeställningarna. Temat Livsåskådning och dödsprocessen beskriver hur reflektion kring livet och mötet med döden naturligt uppstår för de flesta människor, men ger sig till uttryck på olika sätt.   Känsloregistret hos döende ger en bild av hur olika situationer och livssituationer betingar olika känslor, men även här finns det sammanfallande känslouttryck. Dödsacceptans beskriver i vilken grad respondenterna upplever att de döende kommer till en acceptans eller ej.  Betydelsen av relationer framhäver hur essentiellt det är att ha byggt goda relationer i livet, och visar hur detta påverkar dödsprocessen. Den sista fasen in i döden beskriver hur människor växlar mellan liv och död i det sista skedet. Rädsla för att prata om döden handlar om hur många människor undviker att prata om och förhålla sig till döden och döende. Sörjandes sorgeprocess beskriver reflektioner, reaktioner och känslor som respondenterna ser och upplever hos sörjande människor. Resultatet visar att reflektioner och känslor hos döende människor i hög grad är situationsbetingade. Dock finns det ett tydligt sammanhang mellan hur man levt livet och hur man möter döden. När det gäller sörjandes sorgeprocess är tomhetskänslor centralt, men även en upplevd närvaro av den döde. / The purpose of the study was to explore how the clergy, represented by priests and deacons, experience the reflections and emotions of dying and grieving people. A qualitative method was then applied in the form of a thematic analysis. The data collection was conducted through seven interviews, using a semi structured interview guide. The criteria for the participants were being in a work role as a priest or a deacon and having experience with dying and/or grieving people. The thematic analysis generated seven themes as a response to the two research questions. The theme Outlook on life and the death process describes how reflecting on life and death naturally occurs within most dying people, but that it is being expressed in different ways. The range of emotions gives an impression of how different life situations presupposes different emotions, but that it is also possible to see emotional patterns. Death acceptance describes to what extent the respondents perceive that dying people come to an acceptance of their own death. The significance of relationships highlights the importance of building relationships through life and indicates how this affects the death process. The last phase into death describes how people move back and forth between life and death in the final phase. Fear of talking about death concerns the fear many people have of talking about and relating to death and dying people. The grieving process describes the reflections, reactions and emotions that the respondents see and experience in grieving people. The results show that the reflections and emotions of dying people significantly depends on their situation. However, there is a clear connection between how people lived their lives and their death process. For grieving people, a feeling of emptiness is prevalent, and a perceived presence of the dead.

Inledning: Psykoterapisamtal kan vara till hjälp för att minska lidande när en människa drabbas av dödlig sjukdom. Terapier med patienter med dödlig sjukdom kan väcka starka känslomässiga reaktioner hos terapeuten. Forskning gjord inom det psykodynamiska fältet utgår övervägande från fallstudier, varför denna kvalitativa intervjustudie skulle kunna tillföra ytterligare kunskap om hur de känslomässiga upplevelserna beskrivs av psykodynamiska terapeuter. Syftet med studien var att undersöka den psykodynamiska psykoterapeutens upplevelse av terapisamtal med patienter som drabbats av dödlig sjukdom, för att skapa en förståelse för de känslomässiga reaktionerna hos terapeuten.  Frågeställningar: Hur beskriver psykoterapeuten de känslomässiga upplevelserna i det terapeutiska samtalet med patienter med dödlig sjukdom?Vad upplever den psykodynamiska psykoterapeuten är betydelsefullt i samtalen med patienter med dödlig sjukdom?  Metod: En semistrukturerad kvalitativ intervjustudie av fem legitimerade psykodynamiska psykoterapeuter med erfarenhet av terapier med patienter med dödlig sjukdom. Materialet bearbetades med hjälp av tematisk analys.  Resultat: Studien visar att terapisamtal med patienter med döende patienter väcker starka känslomässiga reaktioner hos terapeuten där känslor av hjälplöshet var framträdande. Terapeutens hantering av de starka känslomässiga reaktionerna och relationen till sin egen dödlighet inverkade på hur terapeuten påverkades av samtalen. I en nära och känslomässig relation och med en flexibel terapeutisk ram kunde terapeuten möta patientens starka känslor i processen mot döden, där också en känsla av tacksamhet uppstod hos terapeuten.  Diskussion: Studien belyser på vilket sätt terapeuten påverkas av arbetet med patienter med dödlig sjukdom och hur terapeuten handskas med starka känslomässiga upplevelser. Betydelsen av psykoterapeutens personliga förhållningssätt och flexibla ram och vilka resurser och erfarenheter den psykodynamiska psykoterapeuten behöver för att kunna utföra detta arbete. / Introduction: Psychotherapy can be helpful in reducing suffering when a person is affected by a fatal disease. Psychotherapy with patients who suffer from fatal diseases might provoke strong emotional reactions within the therapist. Research within the field of psychodynamic therapy is predominantly based on case studies, which is why this qualitative interview study could add further knowledge about how the emotional experiences are described by psychodynamic therapists. The purpose of this study was to explore the psychodynamic psychotherapist's experience of therapies with patients who suffer from fatal disease, in order to get an understanding of the therapist's emotional reactions.  Questions: How does the psychotherapist describe the emotional experiences of the psychotherapy with patients suffering from a fatal disease? What does the psychotherapist consider to be important in psychotherapies with patients carrying a fatal disease?  Method: A semi-structured qualitative interview study was conducted with five licensed psychodynamic psychotherapists with experience in psychotherapies with patients who suffer from a fatal disease. A thematic analysis was used to organize the material.  Results: The study shows that psychotherapy with patients who suffer from a fatal disease evoke strong emotional reactions in the therapist, where feelings of helplessness were prominent. The therapist's coping with strong emotional reactions and the relationship to his own mortality affected how the therapist was affected by the therapies. In a close and emotional relationship and with a flexible therapeutic framework, the therapist was able to meet the patient's strong feelings in the process towards death, where a feeling of gratitude also arose in the therapist.  Discussion: The study discusses how the therapist is affected by the work with patients with a fatal disease and how the therapist deals with strong emotional reactions. The importance of the psychotherapist's personal approach and flexible framework and what resources and experiences the psychodynamic psychotherapist needs to be able to undertake these psychotherapies.

This study examines the African-American author Ernest Gaines's three works The Sky is Gray, In My Father's House, and A Lesson before Dying as examples of oppressed manhood, and the gradual acceptance of the characteristics of manhood in Black males. Chapter One focuses on The Sky Is Gray and follows the young hero as he makes his transition from child to a young man understanding manhood. The second chapter looks at In My Father's House, exploring the relationship between father and son. Due to his father's abandonment, the son never learns what it means to be a man. However, at the same time his son is struggling to discover his manhood, the father finally becomes a man. Finally, chapter three centers on A Lesson before Dying, showing two males can learn manhood from each other. Although both are oppressed, together they achieve the manhood that is being robbed from them.

As aid-in-dying legislation expands across the United States, this study examines the dynamics influencing participation in Oregon’s Death with Dignity Act. In addition to data from secondary sources, this thesis analyzes field research data collected in Oregon, including 14 in-depth interviews with volunteers and employees of two advocacy organizations at the center of legalized physician-assisted death. Themes emerged including the conditions that motivate participation, the importance of both personal and professional autonomy, the significance of a good death, and the growth of open dialogues about end of life choices. This thesis concludes with a discussion of the impact Death with Dignity laws could have across the United States, with a specific focus on the state of Tennessee.

Alla former av eutanasi är olagligt i Sverige, däremot väljer allt fler länder att framföra ett mer liberalt perspektiv av det och legalisera det. I sjuksköterskans profession och arbete ingår det att bemöta patienter som har en dödsönskan och efterfrågar eutanasi. Av den anledningen var det av vikt att kunna klarlägga vilka faktorer som påverkar sjuksköterskans förhållningssätt kring fenomenet i de länder som eutanasi utförs. Arbetets syfte var att belysa sjuksköterskans förhållningssätt i mötet med patienter som uttrycker önskan om eutanasi. Metoden som användes var en litteraturstudie där resultaten av tio vetenskapliga artiklar sammanställdes. Datamaterialet analyserades utifrån Fribergs modell. I resultatet redovisades teman som påvisade att det var en emotionell och transformativ upplevelse att delta vid eutanasi, vissa sjuksköterskor upplevde en påtaglig psykisk påverkan av lidandet. Det åskådliggjordes även att religion och kultur hade en inverkan på sjuksköterskans förhållningssätt samt människor utanför vården ex. Familj och samhälle. Det förklarades hur betydelsefullt det var med kommunikation, samarbete och att organisationen samt lagen skapade tydliga riktlinjer att förhålla sig till. I diskussionen lyftes det fram både negativa och positiva aspekter av eutanasi, där sjuksköterskan kunde påverkas av olika faktorer. Etisk stress och maktlöshet var känslor som kunde uppstå hos sjuksköterskan vid bemötande av eutanasi. På liknande sätt stärktes även sjuksköterskan i sin yrkesroll, vilket gjorde det till ett komplext och känsloladdat ämne. / All forms of euthanasia are illegal in Sweden, despite that more countries are deciding to form a more liberal perspective on it and legalise it. Because the nurse plays a central part in the euthanasia process there's a relevance in bringing attention to the phenomenon since it is a complex and emotionally charged subject. Consequently, there is a need for extended knowledge about what factors affect the nurse’s approach towards the phenomenon. Therefore, the aim of this study is to highlight nurse’s approach to euthanasia. The method used for this study is a qualitative literature review based on the results of 11 scientific articles. The contents of the articles were analysed according to Friberg’s analysis model. The results of the analysis are presented in 3 base themes and 6 sub-themes. "Nurse's approach towards participation in euthanasia" highlights how the nurse's experience of participation was transcending and emotional, and some nurses experienced a tangible psychological impact caused by the suffering. "Factors that affect a nurse's approach" shows that religion and culture as well as people outside of healthcare, for example family and society, have an effect on the nurse's approach. "Collaboration in healthcare" explains how important communication and teamwork is, besides that the organisation and the law create clear guidelines. The uncertainty among these factors affects the nurses approach towards euthanasia, often in a negative way. In conclusion, euthanasia is a complex and emotional subject that creates ethical and moral dilemmas for nurse's, dilemmas that will never be discussed enough. Plenty of the nurses described how they often feel uncertain about the subject euthanasia and a clearer communication is important in the euthanasia process.

Background: Despite a longstanding debate regarding personal choice towards death and dying, MAiD was legalized in Canada on June 17th, 2016. Since its integration into the healthcare system, there has been a dearth of literature surrounding providers’ experience with the procedure. Healthcare providers are uniquely positioned within the context of the MAiD experience. Aim: To explore the experiences of health care providers (nurses and physicians) caring for patients undergoing MAiD as well as to explore the relationships between the concepts, Moral Distress (MD), Professional Quality of Life (Burnout (BU), Secondary Traumatic Stress (STS) and Compassion Satisfaction (CS)), and Intent to Turnover (TO). Design: This explorative and descriptive cross-sectional study consisted of a self-reported survey that uses both scale items and open-ended questions. Setting/ Participants: The target population included all nurses and physicians who were active members of a targeted Regional MAiD Network practicing within a designated geographical location within Canada. Results: N=38 Questionnaires completed. The averages of our measured constructs include Moral Distress (Composite) x= 2.9 (SD 2.03), Moral Distress (Frequency): x= 1,18 (SD .102), Moral Distress (Intensity): x= 1.61 (SD .28) Burnout: x= 2.08 (SD 0.5), Secondary Traumatic Stress x= 2.22 (SD 0.48), Compassion Satisfaction x= 4.18 (SD 0.43) and Turnover Intent: x= 2.22 (SD 0.77). Significant positive correlations were found between inter-scale constructs of Moral Distress (Composite, Frequency, and Intensity), Moral Distress, Burnout, and Secondary Traumatic Stress, and between Burnout and Turnover Intent. Significant negative correlations were also found between Professional Quality of life Inter-Scale constructs of Compassion Satisfaction and Burnout as well as between Compassion Satisfaction and Turnover Intent. Conclusion: MAiD providers in our study expressed feelings of their work being “rewarding” and “deeply satisfying”, further reflective in their below-average rates of Moral Distress, Burnout, Secondary Traumatic Stress, Turnover Intent, and higher-than-average rates of Compassion Satisfaction. Although the procedure remains controversial, these participants expressed enjoying their work. These reported positive aspects of their roles persisted despite the challenges the COVID-19 pandemic presented.

Physician assisted suicide (PAS) has been a legalized presence in the United States since Oregon first passed the Death with Dignity Act in 1994. Now PAS is legalized in six states and it is realistic that nurses may encounter PAS during their career. This project explores pre-licensure nursing student attitudes toward PAS. A mixed method design incorporating descriptive correlation and thematic analysis of an open-ended question was used. Surveys were sent to 550 nursing students enrolled in the UCF nursing program asking participants to complete the 34-question survey. This survey included a 12 item “Domino scale” on student nursing opinions toward physician-assisted suicide, and a 23-item demographic scale. Complete, usable results were obtained from 231 participants. Demographic data revealed that the typical participant was between 18 and 25 years of age (80%), female (82%), single (87%), white (69%), in their first two semesters of the nursing program (60%), and unemployed (56%). The total scores for the Domino scale indicated a mean of 40. Regression analyses found that participant experience of someone having asked for help with PAS, and participant religiosity were significant predictors (F = 9.82, p = .0019; and F= 160.36, p < .0001) respectively of nursing student opinions on PAS as measured by the Domino scale. Qualitative analysis produced the following themes related to participant opinion on the nurse’s role in PAS: ways nurses can help with PAS, nurses should not be involved with PAS, clarification and delineation of the PAS process, the preservation of autonomy, the need for more education and inaccurate assumptions of PAS. This study showed that nursing students are moderately in support of PAS and willing to provide care to patients who are terminally ill regardless of a his or her personal decisions regarding PAS. Participants also comment that they desire additional education. Suggestions for further education, practice enhancements, research and policy development are discussed.