A cross-cultural comparison of israeli and american children's death concepts

Abstract

Cross-cultural comparisons are a valuable means of exploring the impact of sociocultural and environmental variables on a child's understanding of the concepts related to death. Exploration of an empirical nature has been hampered by the absence of an appropriate instrument in the English literature for quantifying death concepts in the young child. We report our experience utilizing the Smilansky Death Concept Questionnaire, a structured interview for the examination of human and animal death conceptualization of children aged 4–12 years, in our cross-cultural comparison of Israeli and American lower-socioeconomic-class children in prekindergarten through second grade. Significant differences, with Israeli children performing higher than American children, were noted for all grade levels in two factors, that of irreversibility and finality (with the exception of irreversibility for second-grade children) and for total death concept score. No significant differences were noted for the two remaining factors of causality and inevitability and old age for any grade. Tentative explanations are explored for this observed discrepancy in the nature and level of death concept acquisition between Israeli and American children in this sample, and similarities across cultures are emphasized. Implications of the impact of sociocultural and environmental influences on a young child's developmental understanding of the phenomenon of death are suggested.     

A cross-cultural comparison of israeli and american children's death concepts

Cross-cultural comparisons are a valuable means of exploring the impact of sociocultural and environmental variables on a child's understanding of the concepts related to death. Exploration of an empirical nature has been hampered by the absence of an appropriate instrument in the English literature for quantifying death concepts in the young child. We report our experience utilizing the Smilansky Death Concept Questionnaire, a structured interview for the examination of human and animal death conceptualization of children aged 4-12 years, in our cross-cultural comparison of Israeli and American lower-socioeconomic-class children in prekindergarten through second grade. Significant differences, with Israeli children performing higher than American children, were noted for all grade levels in two factors, that of irreversibility and finality (with the exception of irreversibility for second-grade children) and for total death concept score. No significant differences were noted for the two remaining factors of causality and inevitability and old age for any grade. Tentative explanations are explored for this observed discrepancy in the nature and level of death concept acquisition between Israeli and American children in this sample, and similarities across cultures are emphasized. Implications of the impact of sociocultural and environmental influences on a young child's developmental understanding of the phenomenon of death are suggested.     

Experiences of widows with children: A qualitative study about spousal death in Iran

The experience of the spousal bereavement of widows who are single parents has been largely neglected in the literature. This qualitative study provides insight into how such women grieved over their spouse's death in Iran. In‐depth interviews with 24 participants were held and field notes were written. The generated data were analyzed by using the constant comparative method. The results indicated four main categories: “intense grief”, “becoming hopeless”, “internalizing bereavement and continuing bonds”, and “the contexts of experience of spousal death”. The fourth category consisted of two subcategories: “the unexpected nature of death” and “full dependence”. The findings suggested that hopelessness related to spousal death changed the lifestyles of the participants, which led to health risks in these women. We conclude that it is the duty of health‐care professionals, especially nurses, to first identify widows at risk, with the help of the contexts of experience of spousal death and the symptoms presented in this study, and then to provide hope therapy, which can facilitate positive bereavement outcomes for healthier living after spousal death.     

Parenthood as talked about in Swedish ante- and postnatal midwifery consultations. A qualitative study of 58 video-recorded consultations

In order to explore the manner in which parenthood was discussed in midwifery consultations, 58 video-recorded consultations were analysed. A content analysis revealed a variety of topics concerning conversation on parenthood--topics of an intimate nature and discussions from a societal perspective. Parenthood was not of primary importance in visits, which were mostly directed by the midwives. A phenomenological hermeneutic analysis of the meaning of being a mother revealed a complex and difficult situation of being both needed and dependent. The meaning of being a father revealed a struggle between distancing from and closeness to the child. The mate relationship was indicated as important and under strain. The metaphor of the 'spiders web', where the mother is the spider with the child mostly on her back, the father entering the web on her terms, summarizes the understanding. The results from this study could provide a basis for reflection on the status of the topic of parenthood, on the meaning of being a mother and a father disclosed in the consultations, and ultimately on the organization of ante- and postnatal midwifery care.     

The availability of education on death and dying: A survey of U.S. nursing schools

A stratified random sample of 226 U.S. nursing schools was surveyed to determine the extent and nature of current death education training for nursing students. Of the 205 responding schools, 5 percent reported offering a required death and dying course, while an additional 39.5 percent indicated that a death and dying course was available for their students on an elective basis. The authors challenge the current pedagogical approach toward death education in U.S. nursing schools. They propose the need for the development of a model that would formally link a death education course, or courses, with the clinical phase of training. It is hypothesized that such an approach would enhance the nursing students' recognition and management of their feelings regarding death and dying and therefore result in more effective means of relating to terminally ill patients.     

Decision-making in the treatment of elderly people: a cross-cultural comparison between Swedish and German physicians and nurses

Decision-making in the treatment of elderly people: a cross-cultural comparison between Swedish and German physicians and nurses The aim of the study was to evaluate the comparability of decisions in the treatment of severely ill incompetent elderly patients among physicians and nurses from a cross-cultural perspective. Convenience samples of 192 doctors and 182 nurses from Germany and 104 doctors and 122 nurses from Sweden have been investigated by a questionnaire in a cross-sectional study. Between 39 and 58% of the subjects in the various groups have chosen treatment options, which are not consistent with the patient's will. However, nurses showed a significantly higher compliance than doctors. The probability of choosing cardio-pulmonary resuscitation decreased with increasing information about the patient's wish. Ethical concerns and the patient's wishes appeared as the most important determinants of treatment decisions, whereas the hospital costs as well as the physicians' religion were of minor importance. The inconsistencies concerning decision- making within and between the groups reflect differences in underlying values and lack of societal consensus, which represent a prerequisite for the improvement of patient autonomy. To focus more frequently and to a larger extent onto the problems related to the treatment of severely ill elderly patients as well as onto the training of communication skills with an orientation towards informed consent in the medical training seems to be warranted.     

A study of decision making among U.S. psychiatric nurses

The purpose of this study was to describe psychiatric nurses' decision making and to test a Finnish instrument. A 56-item survey was mailed to 351 psychiatric nurses with a return rate of 48%. A varimax factor analysis showed 5 factors (intuitive, self-confidence, interpretive, collected information, and analytic processing) with alphas ranging from .71 to .85. Results indicate U.S. psychiatric nurses extensively use intuitive interpretive decision making and cultural bias needs to be considered when using a foreign instrument. Further research is needed to refine this instrument and describe psychiatric nurses' decision making.     

Family centred neonatal palliative care in children's hospices: A qualitative study of parents' experiences

Since 1982, children's hospices in the UK have provided services where families can care for their children at the end of life (EOL) in a less medicalised environment. More recently, the services of many children's hospices have extended to newborn babies and their families. This paper explores the experiences of three families (five parents) who availed of children's hospices services when their babies required a palliative approach to care. Early diagnosis of a life-limiting condition in pregnancy allowed advanced care planning and enabled parental participation in decision-making before birth. A homely environment, as well as constant support and a sensitive approach from expert staff encouraged parental involvement in all aspects of their baby's care whilst in hospice. Extended time with their baby after death enabled parents to feel connected with their infant. The holistic and family-centred approach to care from children's hospices is highly valued by parents of newborn babies.     

Struggling for hopefulness: a qualitative study of Swedish women who self-harm

There has been an increase in the number of Swedish psychiatric patients who self-harm, yet self-harm is seldom described in published research. The aim of this study was to describe how people who self-harm experience received care and their desired care. Nine participants, all Swedish women who had been treated for inpatient or outpatient psychiatric care, narrated their experiences of care for self-harm. Using qualitative content analysis, two themes were formulated: 'Expecting to be confirmed while being confirmed fosters hopefulness'; and, 'Expecting to be confirmed while not being confirmed stifles hopefulness'. Each of these themes emerged from five subthemes that clustered around positive and negative aspects of being seen-not being seen, being valued-being stigmatized, being connected-disconnected, being believed-doubted, and being understood-not being understood. Of significance is for nurses to view persons who self-harm as human beings and to grasp the importance of being confirmed by staff that can foster hopefulness in persons who self-harm, yet realize the possibility of the paradoxical nature of hopefulness and being confirmed.     

U.S. and Australian Nurses'Attitudes and Beliefs about the Good Death

The purpose of this study was to ascertain the attitudes and beliefs of nurses in Australia and the United States regarding aspects of passive euthanasia, or the "good death." Two foci guided the study: (a) the possible discrepancies that these nurses might perceive between what they thought would be done in a given clinical situation and what they thought ought to be done, and (6) the possible differences and similarities between the American and the Australian nurses. Responding to the 8 vignettes, 30 American and 32 Australian nurses took part in the study. The lack of agreement between the Australian and American nurses on issues of euthanasia reflects differences in the health care system; the general social position of nursing as a profession; the relationship among health professionals, patients and families, which serves as the context for definition of ethical duties and patient rights; and the role of the law in health care decisions.     

Good death in Japanese cancer care: a qualitative study

One of the most important goals of palliative care is achieving a "good death" or a "good dying process." The primary aim of this study was to identify the components of a Japanese "good death" through qualitative interviews with cancer patients, their families, physicians, and nurses. Semistructured interviews were conducted. Thirteen advanced cancer patients, 10 family members of such patients, 20 physicians, and 20 nurses were recruited from five regional cancer institutions in Japan. Content analysis was applied to answers, and 58 attributes were extracted and classified into 17 categories as follows: Freedom from pain or physical/psychological symptoms, Having a good family relationship, Dying in one's favorite place/environment, Having a good relationship with medical staff, Not being a burden to others, Maintaining dignity, Completion of life, Maintaining a sense of control, Fighting against cancer, Maintaining hope, Not prolonging life, Contributing to others, Control of future, Not being aware of death, Appreciating others, Maintaining pride, and Having faith. The most frequently cited category was "Freedom from pain or physical/psychological symptoms" and the least common was "Having faith." This study identified important components of a good death in Japan. A future quantitative survey is planned to clarify the generalizability of these findings as the primary endpoint of palliative care in Japan.