Concept analysis of good death in the Japanese community

Qualitative study on the perception of good death in patients with end-stage cancer in oncology nurses

OBJECTIVE

To explore the perception of good death of patients with end-stage cancer by nurses in the oncology department.

METHOD

In the study we used a phenomenological approach and semi-structured interviews. A total of 11 nurses from the oncology department of a Grade A hospital in Taizhou were interviewed on the cognition of good death from July 1 to September 30, 2022. Colaizzi's analysis method was used to analyse the interview data. This study followed the consolidated criteria for reporting qualitative research (COREQ).

RESULT

Four themes were identified: a strong sense of responsibility and mission; To sustain hope and faith; The important role of family members; Improve patients' quality of life.

CONCLUSION

The nurses in the department of oncology have a low level of knowledge about the "good death", and the correct understanding and view of the "good death" is the premise of the realization of " good death". The ability of nursing staff to improve the "good death", attention, and meet the needs and wishes of individuals and families, is the guarantee of the realization of "good death".

Spiritual-Cultural Needs as the Main Causative Factor of Death Anxiety in Iranian COVID-19 Patients: A Qualitative Study

COVID-19 patients have been reported to more than likely experience a variety of difficult physical and psychological problems. This qualitative study aims to perceive psychological experiences in COVID-19 patients in Iran. The study method is qualitative, with a conventional content analysis approach adopted. Purposive sampling was applied to 20 COVID-19 patients admitted to medical wards at hospitals in Tehran, Iran. Additionally, data were collected using semi-structured interviews. All data were analyzed based on the method proposed by Lindgren et al. (Int J Nurs Stud 108:103632, 2020). Data analysis identified the main theme to be "death fear and anxiety" with five main categories. These categories included the feelings of death panic and apprehension, uncertainty and ambiguity, fear of abandonment, fear of an unknown future for the family, and fear of unmet spiritual-cultural needs. Accordingly, the patients' experiences of COVID-19 contraction were unique. Against this backdrop, understanding COVID-19 patients' complexities, experiences, beliefs, and attitudes about anxiety and death, can lead to an  improved awareness and understanding of the psychological consequences of COVID-19 by executive decision-makers, healthcare personnel and mental health professionals.

Good death from cancer-the patient view: systematic review of qualitative studies

BACKGROUND AND OBJECTIVE

An in-depth understanding of what constitutes a good death among patients with cancer is vital to providing patient-centred palliative care. This review aimed to synthesise evidence on the perceptions of a good death among patients with cancer.

METHODS

This systematic review involved a synthesis of qualitative data. A three-step process suggested by the Joanna Briggs Institute was used to synthesise the data.

RESULTS

A total of 1432 records were identified, and five articles met the inclusion criteria. Seven synthesised findings emerged: (1) being aware of cancer, (2) pain and symptom management, (3) dying well, (4) being remembered after death, (5) individual perspectives of a good death, (6) individual behaviours leading to a good death, and (7) culture and religions. A structural framework was developed to elicit two layers that could be regarded as determinants of a good death. One layer suggested how multiple external issues impact a good death, whereas the other layer involves patients' internal attributes that shape their experiences of a good death. The elements in the two layers were inter-related to exert a crossover effect on good death in specific cultural and religious contexts.

CONCLUSION

A good death is a process initiated from the time of awareness of cancer and extends beyond demise. Holistic approaches encompassing the management of physical and psychological distress along with psychosocial behavioural interventions to enhance patients' positive perspectives and behaviours are recommended to improve their quality of life and death.

Applying the community readiness model to identify and address inequity in end-of-life care in South Asian communities

BACKGROUND

Individuals from minoritised ethnic backgrounds are less likely than individuals from the dominant ethnic group to access palliative care services and to have documented Advance Care Plans. They are more likely to be admitted to hospital in the last months of life.

AIM

To use the Community Readiness Model to identify the barriers that influence how South Asian communities access and use two new palliative care services.

DESIGN

The Community Readiness Model is a validated tool that measures the readiness of a community. Key stakeholders were asked to: (i) complete a questionnaire to assess South Asian communities' readiness to engage in advance care planning and, (ii) attend a focus group to explore their views on the communities' understandings of palliative and end-of-life care.

SETTING/PARTICIPANTS

Ten key stakeholders who held a variety of occupations within palliative and end-of-life care services were recruited from the community.

FINDINGS

The South Asian communities were found to be at the 'pre-planning' stage of readiness, despite initiatives to improve awareness. The readiness of the health system was found to be limited, with a narrow medical focus during advance care planning, poor integration of voluntary and community services and limited understanding of what people consider a 'good' death.

CONCLUSIONS

The Community Readiness Model allowed insight into the South Asian communities' awareness of and readiness (to use) palliative care services. Using the Community Readiness Model before service implementation allowed steps to be taken to avoid widening inequities in access and use of new services.

'End of life': a concept analysis

BACKGROUND

The concept of end of life (EOL), as in the term end-of-life care, is used synonymously in both palliative and terminal care. Practitioners and researchers both require a clearer specification of the end-of-life concept to be able to provide appropriate care in this phase of life and to conduct robust research on a well-described theoretical basis.

AIMS

The aim of this study was to critically analyse the end-of-life concept and its associated terminology.

METHOD

A concept analysis was performed by applying Rodgers' evolutionary concept analysis method.

FINDINGS

Time remaining, clinical status/physical symptoms, psychosocial symptoms and dignity were identified as the main attributes of the concept. Transition into the end-of-life phase and its recognition were identified as antecedents. This study demonstrates that end-of-life care emerged following the application of the 'end-of-life concept' to clinical practice.

CONCLUSION

The early recognition of the end-of-life phase seems to be crucial to ensuring an individual has well-managed symptoms and a dignified death.

What would it take to die well? A systematic review of systematic reviews on the conditions for a good death

The medicalisation of life under the influence of health-care systems, focused on curing diseases, has made dying well challenging. This systematic review identifies common themes from published systematic reviews about the conditions for a good death as a means to guide decisions around this universal event. MEDLINE, Embase, APA PsycInfo, and AMED were searched for citations with "good death" or "dying well" in their titles on Sept 23, 2020, and complemented with backward reference and forward citation screening with Google Scholar. Articles published in peer-reviewed journals in any language were included. Articles that focused on the identification of conditions for a good death and described how primary studies were sought and selected were also included. Data on general characteristics, quality, and themes were extracted independently. 13 of 275 potentially eligible reviews were included. Common themes were dying at the preferred place, relief from pain and psychological distress, emotional support from loved ones, autonomous treatment decision making, avoidance of futile life-prolonging interventions and of being a burden to others, right to assisted suicide or euthanasia, effective communication with professionals, and performance of rituals. No reviews specified the meaning or timing of death, connected themes, or prioritised them. Vague jargon was often used to describe complex concepts. Most conditions for a good death could be offered to most dying people, without costly medical infrastructure or specialised knowledge. Efforts to describe these conditions clearly, to identify whether there are exceptions or missing items, and whether they apply in non-dominant settings (ie, outstide institutional, affluent, anglophone, and Christian settings) are needed.

Exploring the components of the quality of death in Japanese emergency departments: A qualitative study

BACKGROUND

The need to care for patients who die in the emergency department is increasing in Japan, and emergency nurses are required to provide end-of-life care to ensure that patients experience a good death. However, the components of the quality of death and what constitutes a good death for patients dying in the emergency department are unclear.

AIM

This study aimed to explore the components of the quality of death for patients who die in emergency departments of Japanese hospitals.

METHODS

This study employed a qualitative design. An inductive content analysis was conducted based on semi-structured interviews with 26 participants, which included 15 emergency nurses, five emergency physicians, and six bereaved families.

RESULTS

Seven components of quality of death were identified: (1) transition to the end-of-life phase after receiving the best treatment, (2) dying without suffering, (3) having the patient's wishes respected, (4) having a loved one nearby, (5) maintaining human dignity, (6) having no change in appearance, and (7) not making the family feel guilty.

CONCLUSION

These components suggested that emergency nurses should: support patients' receipt of the best treatment and foster their smooth transition to the end-of-life phase at the appropriate time, ensure that the patients in the end-of-life phase spend time with their loved ones immediately before their death, enable the maintenance of human dignity and patient identity of end-of-life patients, and make sure that the families of end-of-life patients do not feel guilt.

Health Personnel's Knowledge, Attitudes, and Self-Efficacy Related to Providing Palliative Care in Persons with Chronic Diseases

Purpose

The purpose of this study was to examine the relationships of knowledge, attitudes, and self-efficacy related to palliative care among health care providers (doctors and nurses) in order to provide a basis to develop a training program for health care providers.

Methods

A correlational and descriptive study design was used. Participants were recruited from a university-affiliated hospital located in Daejeon and an e-nurse community. After IRB approval, data were collected from July 12, 2018, to September 30, 2018. A total of 169 responses were finally analyzed using version SPSS 24. The data were analyzed in terms of descriptive statistics (frequency and percentage or mean and standard deviation, as appropriate), the t-test, analysis of variance (with the Duncan post hoc test), and Pearson correlation coefficients.

Results

Knowledge, attitudes, and self-efficacy were significantly higher in those who had received palliative care training or had been exposed to awareness-raising initiatives. There were positive relationships among knowledge, attitudes, and self-efficacy, with small to moderate effect sizes.

Conclusion

Palliative care training for health care professionals is necessary to meet patients' needs. Such programs should take into account not only knowledge about palliative care, but also ways to improve empathy and resolve ethical dilemmas. Interprofessional training would be an excellent option to share therapeutic goals and develop communication skills among multidisciplinary team members.

Perceptions on good-life, good-death, and advance care planning in Koreans with non-cancerous chronic diseases

AIMS

This study explored perceptions on a good-life, good-death, and advance care planning in Koreans with non-cancerous chronic diseases with the goal to develop a culture-specific advance care planning intervention in this population.

DESIGN

A qualitative descriptive design was used.

METHODS

Data collections were conducted between September 2017 - June 2018. Twenty-nine patients aged 41-82 years (85.8% men) participated in the interviews lasting 40-60 min. The verbatim transcriptions of the semi-structured interview data were analysed using conventional content analysis.

RESULTS

Good-life was described as 'present with physical and financial independence,' 'not burdensome to the family,' 'completed life responsibility', and 'helping others.' Some participants described good-death as 'prepared death' while others considered it as 'sudden death during sleep.' All participants wanted to have a painless death and not burden the family. Advance care planning was a new concept to many participants. It was likened to 'insurance.' Some participants believed that decision-making on life-sustaining treatment should be done by their family, not themselves, because of economic or emotional distress. Some participants wanted to discuss medical and non-medical care services to reduce the burden on self and family.

CONCLUSION

Family is key when it comes to the meaning of good-life and good-death. Cultural adaptation is necessary to meet the advance care planning needs of Koreans with non-cancerous chronic diseases.

IMPACT

Successfully implementing advance care planning in Koreans with non-cancerous chronic diseases depends on how it is adapted to the disease-specific characteristics compared with cancer, and the cultural norms and social context. Nurses need to be prepared to offer advance care planning to persons with non-cancerous chronic diseases based on a keen sense of and empathetic cultural competence.

International Operating Room Nurses' Challenges in Providing Person-Centered Care During Organ Procurement Surgery

PURPOSE

International operating room (OR) nurses assisting in organ procurement surgery believe that it is their responsibility to provide continued and comprehensive person-centered care to donors through their surgical journeys. This study explored the challenges these nurses encountered in providing person-centered care during surgical care stages of organ procurement surgery in Australia.

DESIGN

The phenomenological approach by van Manen was used to portray 18 OR nurses' organ procurement experiences.

METHODS

Semistructured interview data were transcribed verbatim.

FINDINGS

International OR nurses encountered challenges in providing person-centered care during organ procurement surgery, which were described in different surgical care stages. They faced emotional challenges in handling family grief and clinical challenges in interacting with other health professionals. These challenges could cause personal distress and affect their professional practice.

CONCLUSIONS

Recognizing and managing these challenges is essential for supporting staff and providing quality person-centered care to deceased donors and their families during the organ procurement process.

Personification of Death: What Types of Death Are Personified by Macabre, Gentle Comforter, Gay Deceiver, and Automaton?

Kastenbaum and Aisenberg identified a phenomenon, wherein American subjects personified death in four distinctive figures: Macabre, Gentle Comforter, Gay Deceiver, and Automaton. Until recently, though, researchers did not attempt to answer the question, "What specific aspects of the death experience can be attributed to each of those four personifications?" To answer this question, the current qualitative research asked individuals to envision the causes, places, and contexts of death after imagining each personification of death. The results have revealed that people associated each personification of death with distinct causes, places, and contexts of death: Macabre-murder taking place outside the home, Gentle Comforter-peaceful death by old age at home, Gay Deceiver-death from heart attack, and Automaton-death from cancer in a modern hospital. This article also discusses unanswered questions, limitations, and directions to take its research in the future.

The “Good” Rural Death: A report of An Ethnographic Study in Alberta, Canada

Much concern has centred on the “good” death since the modern hospice/palliative care movement began, and considerable progress has been made in urban services to promote the good death. Little is known about the perspectives of people who live in rural and remote areas of Canada on the good death and how this good death might be enabled in those areas. This report is of an ethnographic study in rural Alberta involving English-speaking Albertans. An identical study in Quebec will be reported elsewhere. The 2006–07 Alberta study involved 13 interviews with individuals to understand their personal viewpoints or perspectives and how they were shaped by their experiences, followed by focus group discussions in two representative rural communities for additional insights from rural policy-makers and care providers. Four themes in the Alberta data highlight critical elements of the good rural death. These findings are expected to contribute to rural/remote palliative and end-of-life care developments.

La Belle Mort En Milieu Rural: A report of An Ethnographic study of the Good Death for Quebec Rural Francophones

An ethnographic study was undertaken in two rural areas of Quebec to conceptualize the good death. The findings reveal that a good quality of life for the dying person and his or her family and friends is essential for a good death. The resulting conceptual model emphasized four dimensions: physical, spiritual, social, and emotional/psychological. These dimensions were determined to be similar to those discovered through a previous urban study, indicating that there may be considerable overlap between good deaths in rural and urban areas. Some findings of this Quebec French-language rural study were similar to those of an Alberta English-language rural study, indicating that rural people may have some common needs and interests with regard to the good death. As such, there could be some common elements of the good death that transcend culture or ethnicity. Chief among these is the desire of rural people to die at home or in their home communities.

Concept analysis of good death in long term care residents

The purpose of this concept analysis paper is to delineate the meaning of good death in long term care (LTC) settings and examine its implications for nursing. The Walker and Avant (2011) method was chosen for this analysis. An in depth literature review identifies uses of the concept and determines the defining attributes of the good death. This paper also illustrates case presentations, antecedents, consequences, empirical referents and implications for clinical practice to clarify the concept of 'good death' in this population. In LTC, death is experienced frequently and is considered the ultimate outcome for most admissions. Much of the existing research on end-of-life care has focused on community dwelling cancer patients whose death trajectory is predictable and who may remain cognitively intact until actively dying. In contrast, the LTC population is older and more likely to suffer from dementia and experience chronic illness for long periods prior to death, and they follow a less predictable death trajectory. In this century, death became the province of older people and the assurance of a good death became the responsibility of those caring for them.

Family Caregiving in Japan: The Influence of Cultural Constructs in the Care of Adults With Cancer

Caring culture is a concept embodying the perceptions and caring practices of caregivers, acknowledging the unique role of cultural beliefs in shaping behavior. A qualitative descriptive study with 13 caregivers of adult family members with a cancer diagnosis in Japan was conducted to gain insight into perceptions and experiences surrounding caregiving. Several major categories were identified, representing rarely reported cultural constructs of high cultural value for the Japanese: On-repayment for what the patient has given, Caregiving as performing a socially expected role, Enryo/meiwaku-restraint in asking for help, Family decision making reflecting strong bonds, Omoiyari-empathizing with the patient's feelings, and Inori-praying to myriad gods and ancestors. The Japanese cultural construct of ie (the strong relationship to family lineage and spiritual connection to past and future generations) is helpful in understanding these categories. Invisible yet powerful cultural constructs permeated caregiving practices. Insights from Japanese cultural concepts and beliefs may foster sensitivity and individualized care in diverse settings, cultures, and societies.

Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue

There is little agreement about what constitutes good death or successful dying. The authors conducted a literature search for published, English-language, peer-reviewed reports of qualitative and quantitative studies that provided a definition of a good death. Stakeholders in these articles included patients, prebereaved and bereaved family members, and healthcare providers (HCPs). Definitions found were categorized into core themes and subthemes, and the frequency of each theme was determined by stakeholder (patients, family, HCPs) perspectives. Thirty-six studies met eligibility criteria, with 50% of patient perspective articles including individuals over age 60 years. We identified 11 core themes of good death: preferences for a specific dying process, pain-free status, religiosity/spirituality, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with HCP, and other. The top three themes across all stakeholder groups were preferences for dying process (94% of reports), pain-free status (81%), and emotional well-being (64%). However, some discrepancies among the respondent groups were noted in the core themes: Family perspectives included life completion (80%), quality of life (70%), dignity (70%), and presence of family (70%) more frequently than did patient perspectives regarding those items (35%-55% each). In contrast, religiosity/spirituality was reported somewhat more often in patient perspectives (65%) than in family perspectives (50%). Taking into account the limitations of the literature, further research is needed on the impact of divergent perspectives on end-of-life care. Dialogues among the stakeholders for each individual must occur to ensure a good death from the most critical viewpoint-the patient's.

Defining a Good Death: A deliberative democratic view

Many attempts to define a good death have been recorded in the academic literature. In most of these attempts, the methods used have been surveys, interviews, and focus groups. These methods have yielded important information, but they have failed to provide an opportunity for public deliberation, whereby people engage collectively with an issue, consider it from all sides, and struggle to understand it. We believe that a well-orchestrated public deliberation could contribute to defining a good death. We gathered data from four deliberative forums implemented in Finland in November 2013. The results paint a picture that differs from those painted by the previous research, which focused mainly on individual and idealized views of a good death. Our findings have brought to light the messy reality of a good death. Deliberation elicited the concern that society could not provide a good death for all and in the process highlighted the lack of proper palliative care and the dominant role of healthcare professionals in defining a good death. Participants also came to terms with the inherent complexity of dying well and gained a better understanding of the challenges related to providing a good death via euthanasia. Their perspectives broadened, proving that defining a good death is a dynamic process rather than a static one.

Determining the factors contributing to quality of life of patients at the last stage of life: a qualitative study

BACKGROUND

Quality- of- life of patients at their last stage of their life are different from that of other people.

OBJECTIVES

The aim of this study was to determine the factors contributing to the quality- of- life of patients at their last stage of their life and provide good cares for these patients.

PATIENTS AND METHODS

This qualitative study was performed by the thematic- framework method of analysis. Twenty three participants including patients, their families, nurses, physicians, psychologists and clergymen were selected sampling. Data were collected by semi - structured interview. We used the thematic framework method to analyze qualitative data.

RESULTS

Seven factors which needed to be considered in the patients' at last stage quality of life included stress reduction, participation, homecare, education, independency, support, recourses and facilities. According to the findings, the number of these factors may be more than what was mentioned above.

CONCLUSIONS

Paying attention to the quality of life at the last stage can be helpful for patients and their families and the special care can be taken for them.

Assessment and Quantification of Taiwanese Children's Views of a Good Death

The concept of a “good death” reflects an individual's positive perceptions of and expectations about death. What constitutes a good death varies based on factors such as sociocultural norms, time, space, and even individual characteristics such as age, culture, and health status. Kehl (2006) maintained that this definitional ambiguity has impeded the implementation of measures intended to appropriately assist the dying because it has been difficult to determine what clinical evaluations and caregiving practices should be used to provide patients with more than “a good death” as it is medically defined. Thus, a more comprehensive and systematic conceptual understanding of this concept is urgently necessary.

Ethnographic study of a good death among elderly Japanese Americans

Most humans desire a good death, but the nursing literature on culture-specific responses to older life, especially on issues of death and dying among Japanese Americans, is still limited. The pattern of beliefs about a good death held by elderly Japanese Americans living in Hawaii was explored. A qualitative study using ethnography and in-depth interviewing was employed. Eighteen healthy and active elderly participants were interviewed, and data analyzed using ethnography to extract categories and themes, and four supplementary interviews with experts were held for triangulation of the data. Four themes emerged, however, in this paper, the predominate one, not being a burden to family, was discussed. The participants believed burdening someone in their culture has an extremely negative implication. Sufficient preparation for older life and death, family support, friends support, and finance were their strategies to avoid being a burden. Nurses need to understand that the concept of good death is unique to every culture. Such knowledge will help them to plan and provide appropriate end-of-life care, and will reduce the risk of living wills being ignored.

Validation of a new measure of the concept of good death among Taiwanese children

The purpose of this study was to develop and validate an instrument to measure dimensions of the concept of a good death held by Taiwanese children. The sample consisted of 1,698 Taiwanese children, approximately 12-14 years of age. Participants completed the self-administered Good Death Concept Scale (GDCS), which consists of 30 statements describing potentially important contributors to a good death that had been identified in the relevant literature. Findings indicated that the GDCS is reliable and valid, as evidenced by the acceptable reliability, the consistent item-total correlations, the successful confirmatory factor analysis modeling, and the significant associations between the scale measuring concepts of a good death and 2 standardized scales (the Multidimensional Fear of Death Scale and the Death Attitude Profile-Revised). The results of this study suggest that GDCS measures 8 distinct domains, each reflecting a different aspect of good death: physical/biological, psychological, social, cognitive, altruistic, spiritual, affective, and rational.

Concept Analysis of Good Death in Terminally Ill Patients

The purpose of this concept analysis of good death was to examine the attributes of a good death and explore the changes of the concept over time and its impact on terminally ill patients. The method used for this analysis was the Rodgers’ evolutionary method. A literature search was completed using Medline Ovid and Journal Storage (JSTOR).The findings describe the evolution of the good death concept over time from the prehistoric era followed by premodern, modern, and postmodern times. In addition, information is presented about surrogate terms, attributes, antecedents, and consequences associated with good death followed by analysis and discussion of the findings. General attributes of a good death include pain and symptom management, awareness of death, patient’s dignity, family presence, family support, and communication among patient, family, and health care providers.

Thai Buddhist families' perspective of a peaceful death in ICUs

AIM

To describe the concept of a peaceful death in intensive care units (ICUs) from the perspective of Thai Buddhist family members.

METHODS

This descriptive qualitative study was based on data generated from individual in-depth interviews of nine Thai Buddhist family members from the southern region of Thailand whose loved ones died in adult ICUs. Colaizzi's phenomenological approach was used to analyse the data. Rigour for the study was established by Lincoln and Guga's guidelines for qualitative research studies.

FINDINGS

Five core qualities emerged that made-up the concept of a peaceful death as described by Thai Buddhist family members who cared for their loved ones while they were dying in ICUs. These core qualities were 'knowing death was impending, preparing for a peaceful state of mind, not suffering, being with family members and not alone, and family members were not mourning'.

CONCLUSION

Thai Buddhist family members described what they meant by a peaceful death. 'This was: preparing for a peaceful state of mind in knowing that one's impending death is not a situation of suffering or being alone, but rather a time of being with family members who are not yet mourning one's death.' The findings support that family members should participate in promoting a peaceful death for their loved ones dying in ICUs.

IMPLICATIONS FOR PRACTICE

The five core qualities of a peaceful death reported in this study could be used as a framework for nurses to create nursing practice interventions for quality end-of-life care for Thai Buddhists.

Thai Buddhists' experiences caring for family members who died a peaceful death in intensive care

AIM

To describe the meaning of Thai Buddhists' lived experiences caring for family members who died a peaceful death in intensive care units.

METHODS

The study made use of hermeneutic phenomenology. The participants were nine family caregivers from the southern Thailand region. Data was generated from individual interviews, and Van Manen's approach was used to analyse and interpret the data.

FINDINGS

Nine themes structured the experiences and were reflected within the four lived worlds of relationality, corporeality, temporality, and spatiality. The participants struggled when making decisions about their family member's life in the context of changing hope. Feelings of stress and exhaustion were common. The participants valued empathetic understanding as a means for maintaining relationships with others in giving and receiving compassionate care. Caring for the self in order to give mindful care and doing one's best in the moment also significantly contributed to achieving a peaceful death.

CONCLUSION

The findings suggest nursing practice guidelines for models of family-centred care and family participation in end-of-life care in intensive care units.

Knowing the occasion of a peaceful death in intensive care units in Thailand

The purpose of this study was to describe how nurses know the occasion of a peaceful death. The data were generated from individual in-depth interviews with ten nurses who practised in adult intensive care units in the southern region of Thailand. Using a content analysis method, four processes of knowing the occasion of a peaceful death were isolated. They were visual knowing, technological knowing, intuitive knowing, and relational knowing.The clinical implications of these processes provide opportunities for nurses to practise the best end-of-life care during a critical time in a patient's life.This study also strengthens cross-cultural nursing during end-of-life care in high-technology settings, such as the intensive care unit.

EvaIuating the "good death" concept from Iranian bereaved family members' perspective

Improving end-of-life care demands that first you define what constitutes a good death for different cultures. This study was conducted to evaluate a good death concept from the Iranian bereaved family members' perspective. A descriptive, cross-sectional study was designed using a Good Death Inventory (GDI) questionnaire to evaluate 150 bereaved family members. Data were analyzed by SPSS. Based on the results, the highest scores belonged to the domains "being respected as an individual," "natural death," "religious and spiritual comfort," and "control over the future." The domain perceived by family members as less important was "unawareness of death." Providing a good death requires professional caregivers to be sensitive and pay attention to the preferences of each unique person's perceptions. In order to implement holistic care, caregivers must be aware of patients' spiritual needs. Establishing a specific unit in a hospital and individually treating each patient as a valued family member could be the best way to improve the quality of end-of-life care that is missing in Iran.

Thai Buddhist intensive care unit nurses' perspective of a peaceful death: an empirical study

AIM

To describe the concept of a peaceful death from Thai Buddhist intensive care unit (ICU) nurses' perspectives.

METHOD

A descriptive qualitative study of data generated from individual in-depth interviews of ten intensive care nurses who practiced in adult ICUs in the southern region of Thailand. Content analysis was used to analyse the data.

FINDINGS

Four core qualities of a peaceful death emerged as described by Thai Buddhist nurses who practised in the ICUs. These core qualities are: peaceful mind; no suffering; family's acceptance of patient's death; and being with others and not alone.

CONCLUSION

Thai Buddhist nurses described a peaceful death as 'a situation in which persons who are dying have peace of mind, and do not show signs and symptoms of suffering. Peaceful death occurs when family members declare acceptance of their loved one's dying and eventual death. Such a death is witnessed by relatives and friends and the dying person is not alone.' The findings encourage nurses to be with, and provide palliative care for, dying patients and families.

A Dimensional Analysis of the Concept: Good Death of a Child With Cancer

The death of a child is painful to all witnesses, but the experience varies among individuals, and differing perspectives lead to a variety of definitions for a good death. This analysis is undertaken to clarify the dimensions involved in a good death of a child with cancer and to examine them from 3 perspectives: the dying child, the child's family, and the health care providers.

End-of-life care: an educational intervention for rural nurses in southeastern USA

AIM

To assess the impact of three educational presentations as an intervention for increasing knowledge of end-of-life care for rural nurses in assisted living and nursing home environments.

DESIGN

A repeated measures design (quantitative component) evaluated the effects of the educational intervention. Two open-ended questions yielded qualitative data.

SAMPLE AND SETTING

A convenience sample (n = 9) of Registered Nurses and Licensed Practical Nurses employed in an assisted living facility or nursing home in the rural, southeastern region of the USA. Level of nursing experience ranged from 6 to 28 years.

ANALYSIS

Frequency distributions, difference of means test for paired samples.

RESULTS

Post test scores were significantly higher (t = 6.999; p < 0.001) than pretest scores regarding overall knowledge on end-of-life care. Attitudes and perceptions of participants changed in defining what constitutes a 'good death'.

CONCLUSIONS

Classroom educational presentations are an effective means of changing attitudes and improving end-of-life care knowledge. Additional education and support for rural nursing personnel involved with residents of long-term care may enhance end-of-life care.