Health care professionals and the near-death experience

It is estimated that 8 million people have undergone a near-death experience (NDE) within the United States today (1). Clinical documentation of this phenomenon has been reported by physicians and nurses, mostly in the area of critical care. Some psychologists have also noted patient reporting of NDEs while under care. Taking into account the improved medical interventions used in bringing people back from states of clinical death, the potential for professional exposure among health care professionals is high. If denied a chance to share their experience with others who might assist in “normalizing” their near-death event, individuals who have undergone an NDE may become severely depressed. It is evident that this is an area of clinical concern that should warrant educational involvement within the fields of health education, psychology, and related human service professions so as to meet better the emotional needs of near-death clients. Some suggestions for meeting these needs are also included.     

"False positive" claims of near-death experiences and "false negative" denials of near-death experiences

Some persons who claim to have had near-death experiences (NDEs) fail research criteria for having had NDEs (“false positives”); others who deny having had NDEs do meet research criteria for having had NDEs (“false negatives”). The author evaluated false positive claims and false negative denials in an organization that promotes near-death research and in psychiatric outpatients. The frequency of false positives and negatives varied in samples that differed in prevalence of, and knowledge about, NDEs. The influence of participants' knowledge about NDEs on the findings of near-death research makes it critically important to use standardized criteria for identifying NDEs.     

The meaning of survival: The early aftermath of a near-death experience

An estimated 9 million adults in this country may have had a near-death experience (NDE), yet little research has been focused on the early aftermath of this extraordinary phenomenon. The purpose of this interpretive study was to appropriate and make visible how patients who had an NDE during a cardiac or respiratory arrest understood and experienced this early period of survival. Gadamerian hermeneutics (1975/1990) informed and guided the study. This interpretation demonstrates that NDEs and their early aftermath can be the positive, life-enhancing experiences that the common lore and most research tend to depict, yet they can also be unpleasant and distressing experiences fraught with emotional pain and angst. ©1995 John Wiley & Sons, Inc.     

Consistency of near-death experience accounts over two decades: Are reports embellished over time?

AIM: "Near-death experiences," commonly reported after clinical death and resuscitation, may require intervention and, if reliable, may elucidate altered brain functioning under extreme stress. It has been speculated that accounts of near-death experiences are exaggerated over the years. The objective of this study was to test the reliability over two decades of accounts of near-death experiences. METHODS: Seventy-two patients with near-death experience who had completed the NDE scale in the 1980s (63% of the original cohort still alive) completed the scale a second time, without reference to the original scale administration. The primary outcome was differences in NDE scale scores on the two administrations. The secondary outcome was the statistical association between differences in scores and years elapsed between the two administrations. RESULTS: Mean scores did not change significantly on the total NDE scale, its 4 factors, or its 16 items. Correlation coefficients between scores on the two administrations were significant at P<0.001 for the total NDE scale, for its 4 factors, and for its 16 items. Correlation coefficients between score changes and time elapsed between the two administrations were not significant for the total NDE scale, for its 4 factors, or for its 16 items. CONCLUSION: Contrary to expectation, accounts of near-death experiences, and particularly reports of their positive affect, were not embellished over a period of almost two decades. These data support the reliability of near-death experience accounts.     

Enhancing oral health for better mental health: Exploring the views of mental health professionals

The association between oral health, self‐esteem and quality of life is well established yet there is limited research on the impact of addressing the poor oral health of people living with mental health disorders. Greater consideration is warranted on how enhancing oral health in the course of mental healthcare might reduce the burden of a person's ill health. The role of mental health professionals is important in this regard yet uncertainty persists about the role these providers can and should play in promoting oral health care for people with mental health disorders. This qualitative study explored the issue of oral health and mental health with community based mental health professionals in Perth, Western Australia. It examined their views on the oral health status and experiences of their clients, and the different and alternative ways to improve access to care, knowledge and preventative regimens. Findings indicated participants’ ambivalence, reluctance and lack of training in raising oral health issues, despite its acknowledged importance, indicating a siloed approach to care. Findings offer an opportunity to reflect on whether a more integrated approach to oral health care for people with mental health disorders would improve health outcomes.     

Reduced death threat in near-death experiencers

Abstract

Near-death experiences (NDEs), profound mystical or transcendental experiences occurring on the threshold of death, have been reported to reduce fear of death and death anxiety. This study compared responses to the Threat Index, a widely used measure of the threat implied by one's personal death, of (a) 135 near-death experiences, (b) 43 individuals who had come close to death but not had an NDE, and (c) 112 individuals who had never come close to death. Death threat was significantly lower among those with near-death experiences than among the two comparison groups, and degree of death threat was inversely correlated with depth of NDE as measured by the quantitative NDE Scale. Self/ideal self discrepancy or, inversely, actualization, was not related to occurrence or depth of NDEs.     

Florida health care providers' knowledge of folic acid for the prevention of neural tube defects

OBJECTIVES: The purpose of this study was to determine the impact of an educational program on the knowledge and practice behavior of health care providers regarding folic acid use for the prevention of neural tube defects. METHODS: A survey was mailed to selected Florida health care providers to determine baseline knowledge and practice behavior. After a statewide educational program, another mail survey was sent to the same groups of providers to determine the effect of the campaign. RESULTS: Comparison between the two surveys showed a significant increase in knowledge and in the percentage of health care providers who recommended the periconceptional use of folic acid for the prevention of neural tube defects. Providers graduating in 1992 or later were more likely than those graduating before 1992 to have the appropriate knowledge about folic acid use but were less likely to recommend it to their patients. CONCLUSIONS: Significant gains were made in increasing knowledge and changing practice behavior among selected Florida health care providers. Regardless of the magnitude of these gains, our data show that some health care providers who have regular contact with women of childbearing age still do not know the recommended doses of folic acid or do not recommend its use. This points toward the need for continued education as well as efforts to modify provider behavior.     

Reduced death threat in near-death experiencers

Near-death experiences (NDEs), profound mystical or transcendental experiences occurring on the threshold of death, have been reported to reduce fear of death and death anxiety. This study compared responses to the Threat Index, a widely used measure of the threat implied by one's personal death, of (a) 135 near-death experiences, (b) 43 individuals who had come close to death but not had an NDE, and (c) 112 individuals who had never come close to death. Death threat was significantly lower among those with near-death experiences than among the two comparison groups, and degree of death threat was inversely correlated with depth of NDE as measured by the quantitative NDE Scale. Self/ideal self discrepancy or, inversely, actualization, was not related to occurrence or depth of NDEs.     

Determinants of health-promoting behaviors in adults

Risk reduction for coronary artery disease (CAD) is a goal of health providers. The purposes of this study were to determine: 1) adults' knowledge about CAD; 2) if adults who have risk for CAD also practice health-promoting behaviors; and, 3) if there is a correlation among adults' practice of health-promoting behaviors, health locus of control, value of health, and knowledge of CAD risk factors. Findings indicate that subjects were knowledgeable about personal CAD risk, and those with higher CAD risk knowledge also practiced more health-promoting behaviors. Subjects had less knowledge about elevated cholesterol levels, diabetes, and use of oral contraceptives. Additional findings suggest that individuals' beliefs about control over their health, health value, and knowledge about CAD risk factors are related to their participation in health-promoting behaviors.     

Consider the Dose

Health care providers have a responsibility to their patients to ensure strict adherence to the international guiding principle “as low as reasonably achievable” for radiation safety. Nurses can pledge their support for this concept and lead through education on radiation safety. We can become radiation cognizant and educate health care professionals on the doses patients receive during computed tomography examinations. This will aid health care providers in deciding the risks and benefits of these exams.     

Health care providers’ perception,knowledge, barriers and practice of kangaroo care for preterm baby in Indonesia

This study explored the health care providers' perception, knowledge, barriers and practice of Kangaroo Mother Care (KMC) for premature infants. Total of 111 participants working in NICU and Perinatology wards from four hospitals in Central Java, Indonesia were recruited to this study. The participants were invited to complete the four sections of the Kangaroo Mother Care Questionnaire. Generally they have been practicing KMC with good perception even with deficient knowledge about KMC. Yet the health care providers perceived high barriers to practice KMC and perceived uncomfortable practicing KMC in certain situation. KMC practice in Indonesia need to be highly promoted to be practiced and campaigned thus the health care providers’ negative perception could be reduced as well as educate them to be more confident practicing KMC with adequate knowledge.     

Capturing Information Needs of Care Providers to Support Knowledge Sharing and Distributed Decision Making

Background

This paper reports on work carried out to elicit information needs at a trans-disciplinary, nurse-managed health care clinic that serves a medically disadvantaged urban population. The trans-disciplinary model provides a “one-stop shop” for patients who can receive a wide range of services beyond traditional primary care. However, this model of health care presents knowledge sharing challenges because little is known about how data collected from the non-traditional services can be integrated into the traditional electronic medical record (EMR) and shared with other care providers. There is also little known about how health information technology (HIT) can be used to support the workflow in such a practice.

Objectives

The objective of this case study was to identify the information needs of care providers in order to inform the design of HIT to support knowledge sharing and distributed decision making.

Methods

A participatory design approach is presented as a successful technique to specify requirements for HIT applications that can support a trans-disciplinary model of care.

Results

Using this design approach, the researchers identified the information needs of care providers working at the clinic and suggested HIT improvements to integrate non-traditional information into the EMR. These modifications allow knowledge sharing among care providers and support better health decisions.

Conclusions

We have identified information needs of care providers as they are relevant to the design of health information systems. As new technology is designed and integrated into various workflows it is clear that understanding information needs is crucial to acceptance of that technology.     

Emergency department care: Cost awareness by health care providers

With the escalation of health care costs during the past decade, it has become increasingly important for the physician to be aware of the cost of various components of health care delivery. The following study was undertaken to ascertain the “cost awareness” of four different groups of health care providers. This was accomplished by having these groups estimate the cost of patient visits to an emergency department. Significant errors were observed in these cost estimations, and error trends were seen to occur that were independent of education and experience.     

Pain prevalence, experiences and management strategies among the elderly in taiwanese nursing homes

The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among elderly residents of nursing homes in Taiwan. Stratified random sampling was used to recruit participants (n = 150). In these elderly nursing home residents, pain prevalence was 65.3% and the average number of pain sites was 3.24 (SD = 2.59). The mean pain intensity was 3.86 (SD = 1.90) and pain interference was 4.30 (SD = 2.28). “Aching” was the word most commonly used (77.6%) to describe pain. Most participants (54.21%) took prescribed medications for dealing with pain; doctors were the main information source for this self-care strategy. Although participants reported severe bouts of pain, they used limited self-care pain management strategies. Since health care providers play an important role in helping the elderly to manage pain, the authors recommend training nursing home staff to perform regular pain assessments and providing current knowledge about pain assessment and management strategies.     

Treading lightly: spirituality issues in mental health nursing

ABSTRACT: Spirituality has been recognized as an important part of nursing practice since its early beginnings. However, debate continues about whether and how nurses and other mental health professionals should include spirituality within their daily work. This paper aims to contribute to the discussion of spirituality within mental health nursing, through considering findings from a Heideggerian phenomenological study conducted with six people with mental illness living in regional Australia. This study aimed to provide a greater understanding of the phenomenon of spirituality by answering a primary research question, ‘What does spirituality mean for people with a mental illness?’ Participants were interviewed and data analysed using an iterative approach. Findings emerged through multiple readings and meanings were gradually constructed from the data into themes. The themes describe that spirituality is experienced uniquely for the participants, and that spirituality became vitally important to them when they became mentally unwell. In addition, issues of interest to mental health nurses were raised but not completely addressed by the study. The issues relate to potential interactions about spirituality between nurses and their patients. Although participants wanted to discuss their experiences of spirituality with others, they raised concerns about whether their mental health care providers would be accepting of their beliefs. Spirituality was deemed to be a highly individual phenomenon; it could be experienced as a journey and it was life‐sustaining. For these reasons, it is proposed that mental health professionals must be prepared to discuss patients’ spiritual needs in the context of their health concerns.     

Issues in Reproductive Health and Empowerment in Perinatal Women with Substance Use Disorders

This article describes perinatal drug dependent women's perspectives on pregnancy, contraception, knowledge of reproductive health, and communication with sexual partners. In this qualitative study, semi-structured interviews were conducted with perinatal residential substance abuse treatment participants (n = 36) regarding their life experiences in the time just prior to drug treatment. Using an analytic framework to examine life dimensions, analysis of the biological and socio-cultural dimensions and their effects was conducted and indicated that pregnancy and motherhood were motivational for women to enter treatment and to seek prenatal care. In addition, the data showed that the women were poorly informed about their reproductive health status and contraception, and experienced difficulty communicating about these issues with male partners. Recommendations for drug treatment and health care systems include strategies for: 1) expansion of women's “empowerment” in recovery to include knowledge and decision-making skills regarding their reproductive health status and 2) development of cross-disciplinary activities aimed at outreach, screening, and assessment of drug dependent women.