Introducing the Study of Life and Death Education to Support the Importance of Positive Psychology: An Integrated Model of Philosophical Beliefs, Religious Faith, and Spirituality

Death education interventions for people with advanced diseases and/or their family caregivers: A scoping review

BACKGROUND

People with life-threatening diseases and their family caregivers confront psychosocial and spiritual issues caused by the persons' impending death. Reviews of death education interventions in the context of life-threatening diseases are scarce and limited to certain intervention types.

AIMS

This study aims to ascertain existing evidence on death education interventions for the population of adults with advanced diseases and/or their family caregivers and identify gaps for future research.

DESIGN

A scoping review guided by Arksey and O'Malley's framework.

DATA SOURCES

Thirteen electronic databases were searched for experimental and qualitative studies on death education interventions for the advanced disease population and/or their family caregivers between 1 January 1960 and 25 October 2023.

RESULTS

Nine types of interventions were identified in 47 studies, which included 5 qualitative and 42 experimental designs, half of which were pilot and feasibility trials. Most of the studies focused on people with advanced cancer, and only seven investigated caregivers or families/couples. Death-related outcomes were less likely to be assessed relative to psychological outcomes, spiritual well-being, and quality of life. Life review interventions, cognitive-behavior therapy, narrative therapy, and general psychosocial interventions decreased depression and anxiety, but evidence was limited. Factors contributing to the interventions' success included intervention content, which enabled the disclosure of personal experience and death concerns comfortably, trained professionals, and connection to family caregivers.

CONCLUSIONS

This work identified a few potentially effective death education interventions for psychological outcomes for people with advanced cancer or their caregivers. Additional trials are needed to confirm the effectiveness of these interventions.

Effects of a death education based on narrative pedagogy in a palliative care course among Chinese nursing students

Background

Death education has been confirmed to be an effective method to enhance nursing students' attitudes and coping abilities toward death. However, integrated Narrative Pedagogy into the death education to explore educational effectiveness is still limited. The study aimed to evaluate the effects of a death education based on Narrative Pedagogy in a palliative care course on the attitude toward death, coping with death, and attitude toward caring for the dying among undergraduate nursing students in China.

Methods

The study was designed as a pre-post intervention study with a quasi-experimental design. All the participants received 6 class hours of death education which was designed in a palliative care course. The death education includes preparation, presentation, discussion, reflection, and practice of the narrative materials. Death Attitude Profile-Revised (DAP-R), Coping with Death Scale (CDS), and Frommelt Attitude Toward Care of the Dying-Form B (FATCOD-Form B) were used to measure outcomes.

Results

Sixty undergraduate nursing students who consented. There were statistically significant increases in the mean score of neutral acceptance and approach acceptance in the DAP-R, CDS, and FATCOD-Form B before and after the intervention.

Conclusion

This death education integrated Narrative Pedagogy which indicated to improve attitude toward death, competence to cope with death, and attitude toward the care of dying patients. The findings assist teachers in understanding the importance and urgency of death education, as well as providing a favorable approach to death education. However, the long-term effectiveness still needs to study in further.

Advancing the study of life and death education: theoretical framework and research inquiries for further development

Life and death education, also known as life education and death education, is an interesting subject that may coincide with the subject of lifespan development. In brief, from our theoretical perspective, which guides our teaching and curriculum development, life education considers personal understanding of life functioning on a daily basis, whereas death education explores matters that are related to death and dying. For example, how can a social worker utilize his life knowledge, or life wisdom, to assist a relative to understand the intricate nature of death? In a similar vein, how can a senior citizen use her personal experience of Buddhist meditation practice to overcome a minor Covid setback? Central to our teaching practice is the premise of 'active transformation' (i.e., transforming life knowledge into positive practice) and the premise of 'theoretical infusion' (e.g., the infusion of a distinctive epistemological belief in the teaching of life) that would, in turn, help to enhance and facilitate deep, meaningful understanding of life and death. The purpose of the present article is for us to discuss a proposition of a theoretical-conceptual model, which depicts the 'unification' or integration of three major viewpoints of life and death: the social viewpoint, the philosophical viewpoint, and the psychological viewpoint. We theorize that unification of the three theoretical viewpoints may help provide grounding for effective teaching and holistic understanding of the subject contents of life and death. Such discourse, importantly, may also assist to advance the scope and complexity of the lifespan development subject. Finally, in addition to our theoretical-conceptual model of life and death, we propose three major research inquiries for development: the meaning of situated mindset, the underlying nature of spiritual transcendence, and proposition of appropriate methodological accounts for usage. Overall, then, we purport that our conceptual analysis and discussion overview, based on philosophical reflection, may serve to stimulate interest, intellectual curiosity, scholarly dialog, etc.

The Influence of Cultural Snapshots on Pre-service Teachers' Attitudes Towards Death Education

Cultural snapshots may be a didactic resource that promotes the understanding of death and provides teachers with tools that can be used to work with students. This study aims to analyse pre-service teachers' attitudes towards death education. A quantitative longitudinal panel design with pre-test and post-test measures was applied, with descriptive, inferential, and predictive approaches. The sample consisted of 161 pre-service primary teachers from a Spanish university who responded to the validated questionnaire "Death Education Attitudes Scale-Teachers" (DEAS-T). The results reveal an improvement in their attitudes towards death education after implementing cultural snapshots in class, producing significant differences between the pre-test and post-test according to gender, in favour of the male participants. The variables of death anxiety and adequate training are relevant for predicting the attitudes of both genders, in addition to the motivation variable in male participants and the variable of interest towards the topic in female participants.

Exploring the needs and barriers for death education in China: Getting answers from heart transplant recipients' inner experience of death

Background

Promoting reflection about death may support better living, and how to carry out death education is an important issue to be addressed across the world. The purpose of the current study was to explore the attitude of heart transplant recipients toward death and their inner real experience to provide information for the development of death education strategies.

Methods

A phenomenological qualitative study was conducted using a snowball method. A total of 11 patients who had undergone heart transplantation more than 1-year ago were recruited for the current study for semi-structured interviews.

Results

A total of five themes were identified: "Not avoid talking about death," "Feeling fear about the pain in the process of death", "Wanting a good death at the end of life," "The richness of feelings during near-death is surprising," and "Being close to death makes people more receptive to death."

Conclusion

Heart transplant recipients have a positive attitude toward death and wish for "good death" at the end of life. These patients' near-death experiences and positive attitudes toward death during the course of their illness provided evidence of the need for death education in China and supported the experiential approach to death education.

Advancing the Study of “Goals of Best Practice”: Toward Achieving Optimal Best – Educational Implications to Developments in Flow Research and Positive Optimal Psychology

The paradigm of positive psychology is significant in introducing positive psychological concepts such as “flourishing,” “optimal best,” and “a state of flow.” In terms of research development of positive psychology, the researchers of this article have made extensive theoretical, empirical, and methodological contributions by advancing the study of optimal best. One aspect of this research, notably, consists of advancement of the psychological process of optimization. Optimization, in brief, provides a theoretical account into the “optimization” of a person’s state of functioning. Non-academically, a Buddhist nun’s seeking to successfully achieve an optimal state of enlightenment or, academically, a first-year student’s seeking to achieve an A grade in Psych 101 would require some form of optimization. Recent research development has, interestingly, considered a related concept known as “goals of best practice” (GsBP), which may co-exist with the process of optimization and/or assist to account for the optimization of learning experiences. This conceptual analysis article, by utilizing the paradigm of philosophical psychology, advances the study of optimal best practice by focusing on three major aspects: (i) to consider conceptually and philosophically how and/or the extent to which GsBP could, in fact, relate to the nature of flow, flourishing, and optimal best; (ii) to consider a methodological account, which could help to measure and assess the concept GsBP; and (iii) to consider the potential practicality of GsBP in educational contexts, which may assist to facilitate and motivate the achievement of optimal best. These three aspects, we firmly believe, are of significance as they provide grounding for implementation and continuing research development into the area of best practice.

Community-based death preparation and education: A scoping review

The COVID-19 pandemic revealed a need for people and communities for death preparation. Few studies have examined community-level interventions for death preparation and education. This scoping review scrutinized the relevant literature following PRISMA 2018 guidelines. Six databases were searched for articles published between 2010 and 2020. We found that cultural, socioeconomic, and individual values affected death preparation and that online courses and life-death education were effective preparation methods. Additional research is needed to identify the population-specific effectiveness of interventions. To fully investigate death preparation and education at the community level, theory-based studies employing quantitative and qualitative methods are also needed.

Empirical validation of the psychological concept of a perceived feeling of 'energy': Advancement into the study of positive psychology

The paradigm of positive psychology, significant in nature, helps to explain the proactivity and motivation of human agency, such as a secondary school student's state of autonomy, confidence, and personal resolve to strive for optimal learning and/or non-learning experiences. Our recent research development, in tandem with other scholars' inquiries, has focused on one aspect of positive psychology-namely, a person's achievement of 'optimal best', which reflects the maximization of his/her state of functioning (e.g., cognitive functioning). Capitalizing on our previous research, we develop a psychological concept that we term as a 'perceived feeling of energy'. A perceived feeling of energy (e.g., a perceived feeling of liveliness) is proposed to act as a 'motivational engine', or as a central driver, which then could predict and enhance a person's achievement of optimal best. Six hundred and twenty-seven university students (N = 438 women, 189 men) responded to a suite of self-report questionnaires. Structural equation modelling (SEM) techniques were used to test a conceptual model, where we focused on the antecedent (i.e., the direct impact of self-efficacy on a perceived feeling of energy) and consequence of a perceived feeling energy (i.e., the impact of a perceived feeling of energy on personal resolve, and the sustaining of optimal best). Analysis of results showed support for our original hypothesized model-for example: self-efficacy as an antecedent of energy and the central role of the energy as a predictor and potential mediator of future outcomes.

Interrelationships Between Psychosocial, Motivational, and Psychological Processes for Effective Learning: A Structural Equation Modeling Study

We tested a theoretical-conceptual model that introduced our recently developed psychological concept, termed as psychological processes, which is defined as "a person's continuing frame of mind to focus on disposition toward strong resolute, structured thoughts and organization, and aspiration to strive for educational success." This proposition is innovative as it considers the notion that a person's mindset is malleable and, importantly, subjects to social experiences derived from a situated social context. Moreover, from our definition, we contend that psychological processes, as a distinct construct, is "latent," or underlying, with three comparable psychological attributes: personal resolve, effective functioning, and personal striving. Our conceptualization, acknowledging the importance of social contexts and individualized experience and personal belief, proposed that perceived social experiences (i.e., positive versus negative), as a source of information, would shape a student's psychological processes, his/her state of motivation, and engagement in different types of adaptive outcomes. Moreover, from our point of view, psychological processes would act as a predictor as well as a potential mediator of motivation and engagement in different types of adaptive outcomes. In a similar vein, from the positive effect of psychological processes, motivation could act as a predictor as well as a mediator of adaptive outcomes. Structural equation modeling, from Taiwanese university students' (N = 739) responses to various Likert-scale measures, showed support for our original a priori model - for example, the positive effects of perceived social experiences on psychological processes (β = 0.81, p < 0.001) motivation (β = 0.61, p < 0.001), and adaptive outcomes (β = 0.36, p < 0.01), and the positive effect of psychological processes on motivation (β = 0.31, p < 0.01). Interestingly, we also found some interesting findings with regard to the effects of measured indicators - for example, the positive effect of personal resolve, as a measured indicator, on adaptive outcomes (β = 0.28, p < 0.001), and the effect of self-efficacy, as a measured indicator, on academic liking experience, also a measured indicator (β = 0.12, p < 0.01). Overall, the results established have a wide range of implications for consideration - for example, the development of an educational program and/or instructional design that could promote and foster positive learning experiences.

A Case for Cognitive Entrenchment: To Achieve Optimal Best, Taking Into Account the Importance of Perceived Optimal Efficiency and Cognitive Load Imposition

One interesting observation that we may all concur with is that many experts, or those who are extremely knowledgeable and well-versed in their respective domains of functioning, become "mediocre" and lose their "touch of invincibility" over time. For example, in the world of professional football, it has been argued that an elite football coach would lose his/her air of invincibility and demise after 10-15 years at the top. Why is this the case? There are different reasons and contrasting viewpoints that have been offered to account for this observed demise. One notable concept, recently introduced to explain this decline, is known as cognitive entrenchment, which is concerned with a high level of stability in one's domain schemas (Dane, 2010). This entrenchment or "situated fixation," from our proposition, may act to deter the flexibility and/or willingness of a person to adapt to a new context or situation. Some writers, on this basis, have argued that cognitive entrenchment would help explain the demise of some experts and/or why some students have difficulties adapting to new situations. An initial inspection would seem to indicate that cognitive entrenchment is detrimental, potentially imparting evidence of inflexibility, difficulty, and/or the unwillingness of a person to adapt to new contexts (Dane, 2010). This premise importantly connotes that expertise may constrain a person from being flexible, innovative, and/or creative to ongoing changes. In this analysis, an expert may experience a cognitive state of entrenchment, facilitated in this case by his/her own experience, knowledge, and/or theoretical understanding of a subject matter. Having said this, however, it is also a plausibility that cognitive entrenchment in itself espouses some form of positivity, giving rise to improvement and/or achievement of different types of adaptive outcomes. Drawing from our existing research development, we propose in this conceptual analysis article that personal "entrenchment" to a particular context (e.g., the situated fixation of a football coach to a particular training methodology) may closely relate to three major elements: self-cognizance of cognitive load imposition, a need for efficiency, and the quest for stability and comfort. As we explore later, there is credence to accept the "positivity" of cognitive entrenchment-that by nature, for example, a person would purposively choose the status quo in order to minimize cognitive load imposition, optimize efficiency, and/or to achieve minimum disruption and a high level of comfort, which could then "optimize" his/her learning experiences. We strongly believe that our propositions, which consider eight in this article, are of significance and may, importantly, provide grounding for further research development into the validity of cognitive entrenchment.

Life, death, and spirituality: A conceptual analysis for educational research development

Life education, also known as life and death education, is an important subject in Taiwan. Life education is more than just the study of a person's development throughout the lifespan (e.g., cognitive development). Within the learning and sociocultural contexts of Taiwan, interestingly, the study of life and death education is concerned with the premise of the promotion and fulfillment of life qualities (e.g., a person's state of contentment), and the meaningful understanding of the nature of death. To facilitate appreciation and deep, meaningful understanding of the subject, and to emphasize its uniqueness, educators have included in their teaching the importance of Eastern-derived philosophical beliefs and religious faiths (e.g., Buddhism). For example, relatively significant in its emphasis, the teaching of this subject involves detailed examination of theoretical accounts of spiritual cultivation and its positive effect on a person's interpretation and enlightenment of life wisdom.

The study of life education, or life and death education, we contend, is of significance as it provides life-related insights and theoretical understanding into the intricate nature of life and death. One notable aspect of the subject entails a person's acquired life wisdom, which in turn may shape his/her life practice on a daily basis (e.g., the proactive engagement in Buddhist meditation). Importantly, the study of life education may assist individuals with their coping of grief, and to approach death with a sense of peace, calmness, and dignity. In this analysis, coupled with Buddhist faith (or any other religious faith for that matter) and facilitated by spiritual cultivation (e.g., the belief in the notion of transcendence experience), a person may overcome grief by believing in the possibility that there is some form of post-death experience and the presence of a loved one's spiritual being. Given this emphasis, we consider an important focus for discussion in this article: to explore the significance of life and death education and to determine how its ‘positive nature’ could potentially yield two comparable implications for development: (i) to engage in appropriate pedagogical practices that would encourage and promote the study of life and death education, and (ii) to advance innovative research inquiries, theoretical, methodological, and/or empirical, which could highlight the significance of life education for life purposes (e.g., the significance of Chinese ideograms, such as 孝).

Introducing 'holistic psychology' for life qualities: A theoretical model for consideration

Positive psychology has attracted extensive interests from educators, researchers, and organizations. Many would recognize the work of Martin Seligman (e.g., Seligman, 2010) and Mihaly Csikszentmihalyi (e.g.,Csíkszentmihályi, 2014b). In its summarized form, positive psychology is concerned with a person's state of flourishing, his/her perceived sense of resilience and inner virtues, and a desire to have positive outlooks in life. Positive psychology is significant, forming the basis for other research inquiries – for example, the advancement of the theory of optimization (Fraillon, 2004; Phan, Ngu and Yeung, 2019b). Considering this evidence, we develop and offer an alternative theoretical model for discussion, which we termed as ‘holistic psychology’.

Holistic psychology, the main focus of this theoretical-conceptual article, is significant for its emphasis on the existence of life experiences, which may exist on a continuous spectrum without distinction between negativity and positivity. This testament, we contend, reflects the importance of inclusiveness and that one could consider maladaptive and negative life experiences (e.g., school disengagement) as sources of vitality, motivating and governing a person to seek for improvement, resulting in a state of flourishing. Our conceptualization in this sense is philosophical, grounded in the main premise of optimization (Fraillon, 2004; Phan et al., 2019b) in which we propose a key tenet for consideration – namely, the ‘transformation’ of negative life experiences into a source of ‘energy’ (i.e., denoted as E) for subsequent enactment. In detail for discussion, our proposed model of holistic psychology consists of four major stages: (i) personal reflection, (ii) the sub-process of transformation, (iii) enactment of energy, and (iv) arousal and sustaining an improved state of functioning.