LIFE AND DEATH DECISIONS: USING SCHOOL-BASED HEALTH EDUCATION TO FACILITATE FAMILY DISCUSSION ABOUT ORGAN AND TISSUE DONATION

Public education that encourages family discussions about organ and tissue donation can enhance understanding, facilitate a donor's wishes and increase the numbers of donations. Action research methods were used to explore the impact of a student-initiated family discussion about donation. Most discussions were positive; only 7% middle school and 4% high school participants described them as “terrible.” “Getting it started” was the most difficult. High school students felt “very” or “somewhat” prepared, whereas middle school students only felt “somewhat prepared”. Guided family discussions ensure that families have accurate information about donation and an opportunity to talk about end-of-life choices in a non-crisis situation.     

The shuttle tragedy, “community grief”, and the schools

The impact of the shuttle disaster on America's schools was the subject of much speculation almost from the moment of the tragedy itself. This article looks at reactions which have taken place since the tragedy. It includes results from a questionnaire administered to teachers and students to examine their reactions four months after the episode, as well as a protocol for dealing with grief in the schools. Both teachers and students felt that they had been totally unprepared for such a loss but they expressed positive views of the role of the media in helping them search for personal “answers” following the shuttle explosion. One point of concern for some educators and parents was the use of “humor” as a coping mechanism by students. The topics of their jokes and stories revealed a concern with bodily integrity/disintegration after the shuttle explosion which they felt that they could not speak about in any other fashion.

The protocol cited in the paper was developed at River Dell High School in New Jersey and has been adopted by a number of public schools. This protocol addresses the different approaches to individual loss and to those losses which have an impact on the entire school community.     

Faculty/student perception of organizational climates in the schools of nursing, Oyo State, Nigeria

This study examined the influence of educational status and gender on the faculty and students' perceptions of their school climates. A self-designed questionnaire was used to elicit information from the 385 subjects (320 students and 65 tutors). Analysis using the t-test technique revealed that there were no significant differences at the 0.05 level of probability in the perceptions of: (a) faculty and students on climate variables “thrust” (t = 0.31) and “control” (t = 1.19); and (b) both sexes on climate variables “thrust” (t = 1.69), “control” (t = 1.13) and “disengagement” (t = −0.53). The conclusion therefore, is that educational status and gender have little or no influence on the peoples' perception of their school climates.     

Factors affecting Adolescents' behavior and attitudes toward destructive rock lyrics

In a study of rock music preferences, listening/watching behavior, and views on destructive rock lyrics, 894 adolescents in grades 9 through 12 in rural, urban, suburban public, and metropolitan parochial schools were administered a questionnaire. Demographic information on parents was also collected. It was found that 17.5% of the students were fans of rock music with lyrics that promote homicide, suicide, or satanic practices (HSSR). Loglinear and multiple regression analyses were used to analyze the data. Parents' marital status, student sex, race, and school environment (urban, rural, suburban, etc.) were found to be significant predictors of HSSR status. As compared with non-HSSR fans, the HSSR fans were more likely to have parents who were “Never married” or “Remarried” and less likely to have parents in the “married” category. The HSSR fans were more likely to be male, white, and enrolled in urban schools but not parochial schools than expected; HSSR status also significantly predicted other music-related attitudes and behaviors. The HSSR fans reported liking both the sound and the lyrics of rock music more often than did non-HSSR fans, as did females and urban students. The HSSR fans more often felt that children under 10 years of age should be allowed to listen to HSSR lyrics, and they more frequently expressed the conviction that HSSR music does not affect adolescents' homicidal or self-destructive behavior. The HSSR fans and females reported more nearly complete knowledge of lyrics than did non-HSSR fans and males. The HSSR fans reported that they watch more MTV than did any other group except rural students.     

Good death inventory: a measure for evaluating good death from the bereaved family member's perspective

The aim of this study was to develop a measure for evaluating good death from the bereaved family member's perspective, and to examine the validity and reliability of the assessment. A cross-sectional anonymous questionnaire was administered to bereaved family members of cancer patients who had died in a regional cancer center from September 2004 to February 2006. We measured the Good Death Inventory (GDI), Care Evaluation Scale, and an overall care satisfaction scale. A retest was conducted one month after sending the questionnaire. Of the 344 questionnaires sent to bereaved family members, 189 responses were analyzed (57%). A factor analysis of the responses to the GDI identified 10 core domains: “environmental comfort,” “life completion,” “dying in a favorite place,” “maintaining hope and pleasure,” “independence,” “physical and psychological comfort,” “good relationship with medical staff,” “not being a burden to others,” “good relationship with family,” and “being respected as an individual.” Eight optional domains also were identified: “religious and spiritual comfort,” “receiving enough treatment,” “control over the future,” “feeling that one's life is worth living,” “unawareness of death,” “pride and beauty,” “natural death,” and “preparation for death.” The GDI had sufficient concurrent validity with the Care Evaluation Scale and overall care satisfaction, sufficient internal consistency (alpha = 0.74–0.95), and acceptable test–retest reliability (ICC = 0.38–0.72). Finally, we developed a short version of the GDI. The GDI is a valid scale to measure end-of-life care comprehensive outcomes from the bereaved family member's perspective in Japan.     

Department of law and ethics

A lawyer representing Nancy Cruzan has filed for a hearing on the grounds that he has three witnesses who will testify that they had “specific discussions with Nancy Cruzan regarding her wishes about life-sustaining medical treatment” (1).     

The ethics of terminal care

The need for a critical and analytical approach to the ethics of terminal care is suggested by considering a series of unexamined questions regarding the justification of terminal care. Among them are: (1) Do patients have a right to terminal care? (2) What qualifies personnel to provide terminal caref (3) Do we really know what “care,” a “good death,” or “accepting one's death” mean? (4) Are assumptions about the hospice model contradictory to the demands of scientific research? If terminal care is, as many seem to believe, a moral and ethical enterprise, then such considerations must be given a more prominent place in discussions of the hospice movement.     

Suicide facts and myths: A study of prevalence

Although statements regarding “myths” about suicide are common in the literature, few empirical investigations have been conducted to determine the extent to which such “myths” are believed. A 32-item questionnaire concerning demographic and clinical correlates of suicidality was administered to 271 college students. Past history of personal suicidal behavior and that of others known to the subjects were also determined. In general, performance was poor with an average score of 59.1 percent, or 18.9 items correctly answered. Subjects with the following characteristics performed best (though still at generally low levels): those with training in suicide prevention or crisis intervention, those with some educational experience about suicide, older students, those with higher college class standing and those enrolled in upper level college courses. In a second study, 49 home health care personnel and 32 individuals being trained to do outreach work with the elderly were given a 16-item subset of the 32-item questionnaire above. Performance was high (approximately 75 percent correctly answered). Nearly all of these items were clinical in nature and were comprised primarily of the “myths” traditionally discussed in the suicide literature. While performance on factual/demographic information was poor in the first study, both investigations found performance on clinical, traditional “myths” about suicide to be high. The implications of these findings for training and education are discussed.     

The empty space phenomenon: The process of grief in the bereaved family

Forty-nine families who experienced a death following childhood cancer were interviewed 7-9 years after the death. Interviews were analyzed using grounded theory technique for qualitative data for the purpose of examining the long-term responses of families to childhood death. In contrast to bereavement theories which claim that grief is usually resolved within two years, findings of this study suggest that many parents and siblings still experience pain and loss after 7-9 years. Analysis suggests that the death of a child creates an “empty space” for surviving family members. Three patterns of grieving were described by family members in response to this sense of emptiness: “getting over it,” “filling the emptiness,” and “keeping the connection.” Differences and similarities of these patterns are enumerated. The perceived significance of the relationship to the pattern of grief is hypothesized. Situations which stimulate a recurrence or continuation of the “empty space” are suggested and changes over time in the bereavement process are described. Further research implications are proposed.     

Barriers that predict resistance to completing a living will

We sought to identify perceived barriers and benefits to completing living wills for 176 medical outpatients or their family members, using a questionnaire based on the Health Belief Model. The regression equation of the patient data identified two items that functioned as significant barriers: “I am not very interested in a living will because I believe that I will live a lot longer” and “Completing a living will now is difficult because I would likely change my mind about how I want to be managed during terminal illness.” No variables remained in the equation when family member data were analyzed. We conclude that a major barrier to the completion of living wills (and perhaps advance directives generally) is that they connote personal death. Implications are explored.     

Deathbed scenes as imagined by the young and experienced by the old

This study compares the deathbed scenes anticipated by students enrolled in university death education courses with the actual deathbed scenes experienced by elderly people with terminal cancer. Most students expected to live into old age and then die (a) at home, (b) with the companionship of loved ones, (c) quickly (usually in a day or less), and (d) without pain or other symptoms, while (e) remaining alert and lucid. Thoughts about an afterlife were seldom introduced. The students' concept of a deathbed scene worse than the expected usually involved the addition of pain or “lingering on.” Respondents found it difficult to improve on their expected deathbed scene because, in effect, they had already substituted “desired” for “most likely to happen.” Location of the deathbed scene in old age is consistent with the probable life expectancy of the respondents, but the easeful death (quick and asymptomatic) is at variance with observations made of terminally ill people. Comparisons are made with data from an ongoing study of deathbed scenes of patients receiving hospice care and from the National Hospice Study. A major purpose of this study is to introduce the deathbed scene as a situation deserving clinical and conceptual attention, and to make available a set of primary coding categories useful in developing a basic data base.     

在校医学生器官移植与捐献态度及认知的调查

背景：在校医学生对器官移植的认知与态度影响着整个社会对器官移植和捐献的认知,进而影响中国器官捐献移植工作的进程。目的：调查在校医学生对人体器官移植与捐献的态度与认知。方法：选择济宁医学院400名学生为被试进行问卷调查。内容主要包括：①对器官移植、器官（遗体）捐献知识的掌握程度。②器官移植、器官（遗体）捐献知识的来源。③对捐献器官（遗体）所持态度。结果与结论：69.8%在校医学生了解器官移植捐献概念,44.6%赞成捐献自己身后器官。说明在校医学生能较好认同器官移植作为治疗终末期器官功能衰竭的有效手段,但对器官捐献所持态度不很乐观,影响其捐献态度的主要因素为家属情感和捐献程序和传统观念。一年级赞同率最低,为26.6%,五年级最高,为61.4%,赞同率随着年级的升高而增加,55.6%的在校医学生认为应该给予器官捐献者一定的奖励或补偿。     

Two perspectives on organ donation: experiences of potential donor families and intensive care physicians of the same event

The aim was to explore how relatives and physicians understood cases where organ donation had been requested and what factors were salient for the decision on donation. Physicians of 25 deceased patients and 20 relatives were interviewed. The material was analyzed using qualitative methods. Eleven patients had declared their wishes on donation before death; in 14 cases the relatives had to decide. Half of these relatives accepted donation and half refused. The donation request was of secondary importance to the families; they were totally occupied by the death and initially tried to avoid the request by regarding “no” as a nonresponse. They needed support to relieve their immediate reactions of uneasiness, start rational thought processes, and reach well-grounded answers. The basis for requesting donation was good; relatives, with regard to circumstances, had been well prepared for the death by continuous information from the physicians and had confidence in staff, accepted that the question was raised, and understood the death criteria. However, about half the physicians experienced conflicts regarding prerequisites of procuring organs and dealing with relatives. Three different approaches were displayed: prodonation, neutral, and ambivalent. Only physicians with a prodonation approach received acceptance for donation.     

Evaluation of people bereaved by suicide

Friends and acquaintances of people bereaved by a suicide in the family tend not to offer effective support. Societal attitudes to suicide and related perceptions (often “misperceptions”) of bereaved family members suggest that friends will not “be there” to the same degree and in the same ways that they would following other sorts of deaths. Thus counselors of those bereaved by suicide deaths must, in their support activities, make allowances.     

Prevalence and screening of dyspnea interfering with daily life activities in ambulatory patients with advanced lung cancer

This study aimed to identify 1) the prevalence of “clinical dyspnea,” defined here as dyspnea interfering with any daily life activities, 2) the impact of dyspnea on daily life activities, and 3) the screening ability of the Cancer Dyspnea Scale (CDS) and the Dyspnea Numeric Scale (DNS). A total of 157 outpatients with advanced lung cancer completed the two scales (CDS and DNS) along with a questionnaire about interference with daily life activities (normal work, walking, sleep, mood, relation with other people, enjoyment of life, and general activities). Over half of this population (55%) experienced “clinical dyspnea.” Dyspnea interfered with not only physical domain (52%), such as walking and work, but also with psychological domain (23%), such as mood and enjoyment. Both scales were feasible for screening of clinical dyspnea. Applying a screening protocol may contribute to avoiding underestimation of clinical dyspnea and lead to appropriate interventions for it.     

Professions, families, and control in the management of the cadaver organ donor

In times of medical crisis, control over the treatment process is vested with the patient's attending physician. The role of the other members of the treatment team is clearly supportive of the physician while the patient's family exercises little or no influence over the treatment process. In certain “rare” events, the traditional roles are suspended and control of the process is, at least temporarily, shifted to an outside group of health professionals. The process of cadaver organ donation is presented as an example of the suspension of traditional role responsibilities and the delegation of control to an external agent. Through direct observation of role interaction, in-depth interviews with medical personnel and a survey of critical care nurses, this process of shift in control is examined. Although the issues of time and the locus of control serve to constrain this process, the decision to accept or decline the request for organ donation ultimately lies with the patient's family. Under these rare circumstances, the family is asked to suspend their beliefs regarding life and death in favor of a new set of norms introduced by this external agent.     

Terri Schiavo: a disability rights case

The author argues that Terri Schiavo was a “person with a disability” who faced disability discrimination, a view that is consistent with national disability rights groups. The author notes that Schiavo was not “terminally ill” and that feeding tubes should not be considered “medical equipment.” The belief that people with severe disabilities want to die is questioned, since many people who acquire severe disabilities change their minds about suicide, and implications for advance directives are explored. Finally, the author notes that although Terri Schiavo was a disabled woman, women's groups did not take up her cause.     

Backyard mushroom ingestions: no gastrointestinal decontamination--no effect

Treating the unintentional “backyard” mushroom ingestion continues to be controversial. A review of pediatric “backyard” mushroom ingestions was conducted. A Regional Poison Information Center (RPIC) conducted a retrospective review of all mushroom ingestions in children younger than 6 years of age. Data were extracted from the RPIC electronic record system for the years 2000–2003. All exposures that involved “backyard” mushroom ingestions with no gastrointestinal decontamination were included. There were 322 mushroom exposures in children younger than 6 years of age reviewed. The mean age reported was 2.1 years (SD ± 1.18). All exposures with a definitive outcome had a 24-h follow-up post-exposure to make this determination. There was no effect in 256 cases (79.5%); minor effect in 6 (1.9%); judged as nontoxic, expect no effect in 20 (6.2%); minimal clinical effects possible in 31 (9.6%); and unrelated effect in 9 (2.8%). It was concluded that “backyard” mushrooms do not present a toxicity hazard in unintentional pediatric exposures and require no gastrointestinal decontamination.