The hospice as a learning space: a death education intervention with a group of adolescents

Evaluation of a knowledge-attitude-practice model based narrative life education program for community-dwelling older adults: a mixed-methods feasibility study

BACKGROUND

The global aging population presents challenges that are particularly acute in China. Older Chinese adults' attitudes towards death significantly impact their quality of life. Death education is crucial for promoting positive perspectives on life and death. Narrative education offers a promising approach to facilitating death education. Integrating the Knowledge-Attitude-Practice (KAP) model into death education will enhance the feasibility and acceptability of death education programs.

METHODS

This mixed-methods feasibility study included a quasi-experimental trial and semi-structured interviews. Older adults in the intervention group (N = 27) received a 6-week KAP-based narrative life education program in addition to standard community health education; participants in the control group (N = 20) received only the normal community health education. In both groups, attitudes toward death and the meaning of life were assessed at baseline and immediately after the intervention. A post-intervention semi-structured interview and satisfaction survey were also conducted for the intervention group.

RESULTS

Forty out of 47 older adults completed the program for an 85.1% retention rate. All of the older adults in the experiment were very satisfied and satisfied with the life education program, and no adverse events were reported. Compared to the control group, participants in the intervention group had a significant decrease in the fear of death (P = 0.028), and substantial improvement in their value of life (P = 0.031), goal of life (P = 0.035), freedom of life (P = 0.003), and the total score for purpose in life (P = 0.017). The qualitative results yielded four themes: profound recognition of life and death, contradiction between thoughts and action, conflict between one's acceptance and others' avoidance, and evaluation of the life education program.

CONCLUSIONS

The KAP-based narrative life education program is feasible and acceptable for older Chinese community-dwelling adults. It is also potentially effective in improving attitudes toward death attitudes and the meaning of life in this cohort.

TRIAL REGISTRATION

This study was retrospectively registered at China Clinical Trial Registry as ChiCTR2300069551 on 2023-03-20. URL of registration: https://www.chictr.org.cn/showproj.html?proj=183176 .

Exploring Emotions Related to the COVID-19 Pandemic through Death Education: A Qualitative Study at Italian Primary Schools

BACKGROUND

The COVID-19 pandemic has impacted the lives of individuals, families, and children worldwide. In Italy, the implementation of measures such as lockdowns and distance learning in schools affected the mental health of children and families.

METHODS

This article employs a qualitative method to explore the efficacy of a death education project that aimed to help primary school children process the emotions and losses that they experienced during the COVID-19 pandemic. The study encompassed both the children who took part in the death education project and their teachers and parents to investigate their perspectives on the emotions of the minors and the effectiveness of the project.

RESULTS

Distance learning posed challenges for the learning process and exacerbated social inequalities. The children suffered from limited social contact with their friends and experienced negative emotions, including anger, fear, and concern for the health of their loved ones. The death education project provided a safe space for children's emotional expression and facilitated their acquisition of coping strategies. Open communication between adults and children about illness and death proved effective in mitigating the psychological impacts of loss and preventing traumatic bereavement.

CONCLUSION

The findings highlight the utility of death education in enhancing children's ability to express their emotions and approach the topic of death more frankly.

Death education for Palliative care: a european project for University students

BACKGROUND

The need to spread the culture of palliative care and to train health care professionals from undergraduate courses is recognised internationally. The article presents the outcomes of a project devoted to palliative care training in university courses in four countries.

AIMS

This article considered the outcomes of a course designed for university students who had the potential to work in a palliative care team. The main aim was to check the efficacy of the course and the motivation to work in palliative care settings, considering the impact of fear and representations of death.

METHODS

The project presented the essential contents related to palliative care, using psychodramatic and photo-voice techniques. Longitudinal measurements were taken using a quantitative method design to detect changes among the students involved. The project involved 341 students at the first administration of the survey consisted of a protocol composed of standardized questionnaires in five countries (Austria, Israel, Italy, Poland and Romania), of whom 276 completed the pre- and post-surveys-165 of them in the experimental group and 111, in the control group.

RESULTS

The experience showed that it is possible to address death-related issues seriously and competently without necessarily causing discomfort and despondency in students. The results of the changes over time in the experimental and control groups highlight how the view of death as annihilation is correlated with the fear of death and the need for avoidance of thoughts concerning dying. The main result is that competence in palliative care facilitates familiarisation with issues of death and dying, as well as the ability to work in this area, thereby enhancing interpersonal skills.

CONCLUSION

The project showed that it is possible to implement death education on palliative care topics in undergraduate courses to increase motivation to work in this field.

A meta-analysis of nursing students' knowledge and attitudes about end-of-life care

OBJECTIVES

To synthesize nursing students' knowledge and attitudes about end-of-life care and to identify strategic directions for optimizing end-of-life care education.

DESIGN

A meta-analysis of observational studies.

DATA SOURCES

PubMed, Web of Science, EMBASE, CINAHL, PsycINFO, MEDLINE, CNKI, and WANFANG 8 electronic databases in English and Chinese were systematically searched from inception until 10 April 2022.

REVIEW METHODS

Two reviewers independently screened literature and extracted data using structured tables. The Agency for Healthcare Research and Quality (AHRQ) was used to appraise the methodological quality of included studies. The study outcomes were synthesized using a meta-analysis.

RESULTS

26 cross-sectional studies of medium or high quality from 13 countries met the eligibility criteria, involving 9749 nursing students. In our review, nursing students demonstrated insufficient knowledge about end-of-life care, with a pooled mean score of 7.50 (95 % CI: 6.55-8.45); of these, knowledge about philosophy and principles, psychosocial and spiritual care, and pain and symptom management were all deficient, with pooled mean scores of 1.49 (95 % CI: 0.78-2.21), 1.00 (95 % CI: 0.35-1.65), and 3.44 (95 % CI: 2.25-4.63), respectively. Conversely, nursing students showed positive attitudes toward end-of-life care, with a pooled mean score of 102.97 (95 % CI: 99.43-106.51). The subgroup analysis revealed that male nursing students had lower pooled mean scores for end-of-life care knowledge and attitudes.

CONCLUSION

There is a mismatch between nursing students' knowledge and attitudes about end-of-life care, they have a positive attitude but lack the necessary knowledge. Male nursing students seem to have a greater deficit of knowledge and a relatively conservative attitude toward end-of-life care. These findings may provide a significant reference for nursing educators to adjust educational strategies promptly.

The Co-Construction of an Elegant Ending-Polyphonic Musical Intervention in Palliative Care: A Case Study

The complexity of creative processes, within which human nature pines and finds itself, reflects a state of relational emergency. The weak structure of our multicultural system gives us a series of behavioral flaws, denouncing our inability to welcome diversity and treasure it. In the search for the way out, using the metaphor of polyphony is increasingly frequent. However, since the term Polyphony is borrowed from musical language, it would be necessary to experience it concretely, and this usually does not happen. Those musicians who aspire to be artists in helping relationships should constantly train themselves in this sense and force themselves to make their ability understood externally, helping those who for reasons of life find themselves experiencing the limit. The field of palliative care is probably the most suitable socio-cultural setting for getting in touch with the personal (mis)interpretations, idiosyncrasies, and pain of those who feel close to the end. To their aid, the aesthetic criterion advances. Making sacred the unifying experience of loss and finiteness turns into an educational process moreover therapeutic, in the co-construction of an elegant "finale" able to reach the heart and intelligence of those who remain.

Psychoeducation Reduces Alexithymia and Modulates Anger Expression in a School Setting

Bullying and violence are relevant issues in school settings and negatively impact students’ well-being and mental health. Psychoeducation and anti-bullying programs may prevent violence among students by addressing emotional expression and regulation, alexithymia, and anger. We describe the impact of a psychoeducational intervention delivered to 90 male and 101 female school youths (N = 191), aged 12–14 years old, and aimed to improve their emotional recognition and regulation, as well as to reduce alexithymia in order to prevent aggression and bullying episodes. A psychological assessment has been performed before (T0) and after (T1) the intervention including levels of alexithymia, measured with the Toronto Alexithymia Scale-20 (TAS-20), the State-Trait Anger Expression Inventory (STAXI), Empathy Quotient (EQ), and the Emotion Regulation Questionnaire (ERQ). Females have shown higher levels of alexithymia at baseline whereas other characteristics (anger, empathy quotient and emotional regulation) did not differ among sex groups. The psychoeducational program significantly increased the empathy quotient (+10.2%), the emotional regulation reappraisal (+20.3%), and the assertive anger expression (+10.9%); alexithymia significantly decreased after the intervention in all the samples (−14.4%), above all among students scoring ≥61 at TAS-20 (−48.2%). Limitations include a small sample from a single school setting, the lack of a control group without psychoeducation, and an assessment based on self-reported measures. We may conclude that psychoeducation has significantly reduced levels of alexithymia and improved empathy and emotional regulation among adolescents.

Influencing factors of attitudes towards death and demands for death education among community-dwelling Chinese older adults: a cross-sectional study

Background

Considering older adults are getting closer to the end-of-life and face death more directly. Attitudes to death not only affect the physical and mental health of older adults, but also affect their acceptance of hospice care, even the quality of death. This study aims to explore the status, influencing factors of attitudes toward death and demands of death education among the community-dwelling older adults in southwestern China.

Methods

A cross-sectional survey was adopted to investigate 683 community-dwelling older adults in Chongqing, China. Non-parametric test and multiple linear regression analysis was used to explore the influencing factors of different attitudes toward death of older adults in community.

Results

The multiple linear regression models showed that different dimensions of death attitudes were affected by one or more factors including number of diseases, discussion about life and death, marital status, and average income per month. And community-dwelling older adults have high level demand for death education.

Conclusions

Under the taboo culture of death in China, this study is one of the few studies on the attitudes toward death and the demands for death education of the community-dwelling older adults. This study contributes to enrich the global death studies and provide reference for the death education for older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13655-2.

Construction of life-and-death education contents for the elderly: a Delphi study

BACKGROUND

Life-and-death education is intimately related to palliative-and-hospice care. It should be implemented among groups of all ages, especially for the elderly. This study aims to establish expert consensus on a set of scientific and systematic life-and-death education contents for the elderly and provide reference for the practice on the elderly.

METHODS

This study designed three rounds of expert consultation by using a Delphi method. A panel of 22 experts from the fields of palliative-and-hospice care, life-and-death education, geriatric nursing, humanities and ethics, and geriatric psychology participated in the study.

RESULTS

This study finally reached expert consensus on the contents of life-and-death education for the elderly, containing 4 first-level items, Life-and-death literacy promotion in the elderly; Life-and-death concept establishment of the elderly; Life-and-death planning of the elderly; Life-and-death thoughts of the elderly with affiliated 9 second-level items, and corresponding 23 detailed third-level items.

CONCLUSIONS

The life-and-death education contents for the elderly offer a basis for publicity for health professionals, promote dialogues on death, preparation, and planning for death and dying. The life-and-death education contents system was clear in coherence containing definite and comprehensive contents, which enriched life-and-death education resources globally. The results could assist in the planning of palliative-and-hospice care services to improve quality of death of the elderly.