This thesis is primarily based upon unstructiared interviews with nurses about their experiences of and attitudes towards nursing the dying. The main focus of the thesis is upon nursing the long term dying within a general hospital as seen from the nurse's viewpoint. The research is based upon the work of Glaser and Strauss which identified patterns of communication between health care workers and dying patients as being crucial to the experiences of the dying, and is broadly supportive of their findings. Many of the nurses interviewed expressed a preference for nursing dying patients who were aware of their dying. However, despite this preference for 'openness' most nurses reported difficulty in achieving this situation. Nursing the dying in an open awareness context was associated with enotional involvonent with the dying, and with satisfaction from such nursing care. It is argued that open awareness and good nursing care of the terminally ill is more likely to occur under a system of individualized patient care which is coupled with team support of individual nurses. The other features which affect the likelihood of open awareness developing are patient characteristics, doctors' views about disclosure, and individual characteristics of nurses.

No description available.

Thesis advisor: Andrea Vicini / Thesis advisor: James Keenan / In this thesis, I am going to explore some of the significant legal and medical activities that have had a great influence on the healthcare delivery in the United States of America, focusing on the care of people that are severely sick or those whose death is imminent. Then I will discuss how the application of virtues, particularly the cardinal virtues, can inspire people not to neglect the needs of patients whenever some helpful procedures could be done, and also to enable people to desist from engaging in medical procedures that could be deemed futile. Patients and their caregivers can all benefit from cultivating virtue and hence create a way of life that respects the human dignity of patients and also uses the available resources prudently for the sake of the common good. Ultimately, I hope to suggest some theologically sound proposals that are helpful to a patient, the patient’s family and the rest of the country’s health system, with a particular focus on an ethical way of delivering healthcare services. I will show how the developments in the Western world can be applied to develop some protocols of healthcare delivery that could be helpful to Kenya. It is my belief that the universal applicability of virtues can ensure that healthcare activities uphold the human dignity of patients, provide respect for healthcare work, and also use a country’s limited resources prudently. / Thesis (STL) — Boston College, 2016. / Submitted to: Boston College. School of Theology and Ministry. / Discipline: Sacred Theology.

The association between carers' satisfaction with services delivered by district nurses (DNs), general practitioners (GPs), hospital doctors (HDs), and the health and social services in general (HSS), and various service and non-service variables was examined to assess whether satisfaction is more a reflection of the service characteristics, the non-service related factors, or attributable equally to both. Analysis was undertaken on a sub-sample of the 'Regional Study of Care for the Dying', a retrospective survey assessing the perceptions of 3696 carers of services delivered to deceased in their last year of life. The sub-sample consisted of 1858 carers of deceased who were relatives or close friends/neighbours, whose deceased died from cancer, and whose death was not sudden. Satisfaction variables were derived from questions recorded in the survey. In bivariate and multivariate analysis, larger odds ratio were found in association with service than non-service variables. For example, high satisfaction with DNs was strongly associated with visiting the patient very frequently (OR= 10.8, 95% CI= 4.5-25.9); and the GP visiting 20 times or more (OR= 5.5, 95% CI= 3.6-8.5), and informing the carer of the diagnosis (0R= 3.3, 95% CI= 2.3-4.7) were associated with high satisfaction with GPs. Examples of non-service factor associations included, for example, good postbereavement psychological state positively associated with high satisfaction with DNs (OR 2.3, 95% CI= 1.6-3.4) and GPs (OR= 2.0, 95% CI= 1.4-2.8); while perceiving caring as rewarding as opposed to a burden was positively associated with high satisfaction with DNs (OR= 3.7, 95% CI= 1.8-7.5) and negatively associated with high satisfaction with hospital doctors (OR= 0.46, 95% CI= 0.24- 0.86). The fmdings reflect, in part, the literature on satisfaction in other areas of health care, but there are some differences, for example sociodemographic variables such as age, sex, religious denomination, and housing tenure were found to have no role in predicting satisfaction with DNs, GPs, and HDs. In post-bereavement surveys evaluating palliative care, carers' satisfaction reflects service characteristics but it is also partly determined by important patient and carer characteristics.

No

Yes / Dying, death and bereavement do not occur in a social vacuum. How individuals and groups experience these phenomena will be largely influenced by the social context in which they occur. To develop an adequate understanding of dying, death and bereavement we therefore need to incorporate a sociological perspective into our analysis. This paper examines why a sociological perspective is necessary and explores various ways in which sociology can be of practical value in both intellectual and professional contexts. A case study comparing psychological and sociological perspectives is offered by way of illustration.

No / This article is a review of Robert Kastenbaum's 1979 essay entitled "Healthy dying: A paradoxical quest continues." It begins with a summary of the arguments and challenges in the original essay. This is followed by an evaluation of his original claims in the light of contemporary insights in modern public health history and empirical studies of near-death experiences and death bed visions. The recent development of health promotion in palliative care is described in relation to these developments and Kastenbaum's early question about the paradoxical quest for health while dying is again posed against this background. Given our modern understanding of "health" in current global health policy and debates, it is argued that "healthy dying" is no paradox. Instead, the pursuit of health at the end of life represents a realistic modern desire to compress morbidity, minimize unnecessary suffering, and enhance quality of life at this time.

No description available.

Yes / This paper introduces a new approach to understanding the dying industry in Pompeii. This study began with the construction of a full-scale replica dyeing apparatus, copied from remains in Pompeii, to establish the operating parameters of an apparatus. A determination of cycle time, fuel type and requirement was made. The skeletal data of Herculaneum was matched to a modern population and an ergonomic assessment of each dyeing apparatus was made. The replica was amended to allow exploration of the eff ects of a change in design and ventilation. A computer simulation using Finite Element Analysis was undertaken. The design, cycle times and temperatures were taken from the excavated remains and experimental fi ndings. The FE Analysis allowed the determination of physical changes in materials during heating, the mode of failure of the apparatus and the time span within which this occurred. The approach and fi ndings of this study are both novel and new. The study took a theoretical problem through replicative experimental archaeology into Finite Element modelling. It allowed the problem to be understood and explored by those from diff ering disciplines. While this study answers specifi c questions about the size of the dyeing industry, it may be used to illustrate the application of a technique to answer `unanswerable¿ questions.

Doctor of Juridical Science / This thesis challenges a number of claims that are made in the context of the euthanasia debate: that there is only one version of the good death; that rights discourse is the most appropriate vehicle by which to secure legal recognition of a right to die; that the Netherlands is either a model for reform or the epitome of a slippery slope in its regulation of euthanasia; and that a key argument in the euthanasia debate, the sanctity of life doctrine, is a fixed, immutable concept. In this thesis I use process sociology, developed by Norbert Elias, in order to capture changing sensibilities toward death and dying in the common law jurisdictions (Australia, England, the United States of America, Canada and New Zealand) and in the Netherlands. At the same time I analyse changing attitudes among key groups whose work impacts upon the euthanasia debate namely, parliamentarians, law reform bodies, the judiciary and medical associations. My aim in adopting this approach is threefold. First of all, to examine evolving attitudes to death and dying in order to determine whether the institutions of law and medicine are responding in an adequate manner to changing sensibilities in the common law countries and in the Netherlands. Secondly, to highlight shifting balances of power within the euthanasia debate. Thirdly, to assess whether the various options for reform that I discuss are workable or not. In this thesis I show that there appears to be a sensibility of support in the common law countries for euthanasia to be legally available when an adult is terminally ill, is experiencing pain that he or she cannot bear and has expressed a wish to die (the typical euthanasia scenario). However, the situation is far from clear cut. The methods adopted by one of the ways of measuring sensibilities, opinion polls, suggest that sensibilities may not always be well-informed. Further, attitudes within and between key groups are not uniform or settled. In the context of this unsettled state of affairs, I show that responses to changing sensibilities from law and medicine in the common law jurisdictions are far from satisfactory. So far as legal responses are concerned, case law outcomes in right to die applications suggest a lack of flexibility. Outcomes in prosecutions following active voluntary euthanasia or assisted suicide reveal a non-application of established legal principles and suggest that the courts do not focus, squarely, upon the real issues at stake in the euthanasia debate. Medical responses are similarly less than optimal due to a tendency to de-emphasise existential (emotional) pain which, research shows, is the prime motivating factor in requests to be assisted to die sooner. Responses to changing sensibilities to death and dying in the Netherlands are also unsatisfactory because of the disorganised manner in which euthanasia was legalised and because regulation is inadequate. I come to the conclusion that there are three ways in which we could possibly resolve these problems and increase the flexibility of responses to changing sensibilities toward death and dying. They are as follows: by legalising euthanasia; by permitting a defence of necessity; or, by liberalising the use of terminal sedation in end-of-life care. Of these three, I conclude, in light of shifting sensibilities and overall negative attitudes among key groups to euthanasia, that the last is the most appropriate option at the present time. In closing, I address some of the larger issues at stake in the euthanasia debate. In particular, I deal with the effect that changing sensibilities toward the process of dying have had upon human social life, leading to the problematic situation that Elias referred to as the ‘loneliness of the dying’.