Views, emotional Reaction, and Bereavement Healing Rituals of Saudi Male Nursing Students: A Qualitative Approach.

AIM: The study described the perception and attitude of Saudi male nursing students towards death and dying. METHODS: This qualitative study recruited Twelve male Saudi nursing students from Nursing Department at University, Riyadh, Saudi Arabia. Data collection was conducted using unstructured one-on-one online interviews from January to February 2021 using thematic approach to analyse the data. RESULTS: The result of the study presented three themes. The first theme describes the Muslim Saudi male nursing student's religious beliefs and practices in terms of three concepts. The second theme is the emotional reaction of the participants. The third theme is bereavement healing rituals. CONCLUSION: The knowledge on how nursing students with an Islamic belief view the concept of death and dying provides valuable and critical information on developing educational intervention as well as course and training contents that needs to be included in developing the competencies of these students.

Chinese medical teachers' cultural attitudes influence palliative care education: a qualitative study.

BACKGROUND: China holds one fifth of the world's population and faces a rapidly aging society. In its ambition to reach a health care standard comparable to developed countries by 2030, the implementation of palliative care gains special importance. Until now, palliative care education in China is limited and disparate. This study aims to explore and determine factors that have impeded the development and implementation of palliative care education in China. METHODS: We conducted semi-structured interviews with n=28 medical teachers from seven Chinese universities. Interviews were transcribed, and thematic analysis applied. RESULTS: Three themes with two subthemes were constructed from data analysis. Theme 1 covers the still ambivalent perception of palliative care and palliative care education among participants. The second theme is about cultural attitudes around death and communication. The third theme reflects participants' pragmatic general understanding of teaching. All themes incorporate obstacles to further implementation of palliative care and palliative care education in China. CONCLUSIONS: According to the study participants, palliative care implementation through palliative care education in China is hindered by cultural views of medical teachers, their perception of palliative care and palliative care education, and their understanding of teaching. The study demonstrates that current attitudes may work as an obstacle to the implementation of palliative care within the health care system. Approaches to changing medical teachers' views on palliative care and palliative care education and their cultural attitudes towards death and dying are crucial to further promote the implementation of palliative care in China.

Perceived Impediments to Completed Brain Autopsies Among Diverse Older Adults Who Have Signed a Uniform Anatomical Gift Act for Brain Donation for Clinical Research.

Background: A small number of older adults in the United States who agree to brain donation for clinical research belong to diverse racial, ethnic, and economic groups. Those who agree, however, are less likely to have completed brain autopsies compared with older non-Latino Whites of higher socioeconomic status. As such, our understanding of Alzheimer's disease and related dementias remains limited in these underrepresented and understudied populations. Here, we examine perceived impediments to completed brain autopsies among diverse older adults who have agreed to brain donation for clinical research. Methods: Participants (N=22) were older adults (mean age=77 years) who self-identified as African American (n=8), Latino (n=6), or White of lower income (n=8). All participants had previously agreed to brain donation via the Uniform Anatomical Gift Act. Each participant took part in a one-time, semi-structured focus group. Data were analyzed using a Grounded Theory Approach with both Open Coding and Constant Comparative Coding. Results: Perceived impediments to completed brain autopsies varied by group. Older African Americans and older Latinos expressed concern about a lack of follow-through by family members regarding their brain donation wishes. Older Whites of lower income indicated that their own uncertainty surrounding the processes of brain donation and brain autopsy might serve as an impediment. Discussion: Diverse older adults expressed different perceived impediments to having brain autopsies completed upon their death. Continuous education for diverse older adults and their family members regarding brain donation for clinical research, including clear guidelines and processes, may facilitate completed brain autopsies among diverse older adults.

The relationship between death obsession and religiosity in non-demented Muslim residents of a nursing home in TunisiaDeath obsession and religiosity.

BACKGROUND: Death distress is a significant problem in the older population and may be more pronounced in certain vulnerable older people, including those living in nursing home facilities. We aimed to assess death obsession (DO) in elderly people without dementia living in nursing homes, and to examine the association between DO and religiosity. METHODS: We carried out a cross-sectional survey involving 42 elderly subjects living in a nursing home in Manouba, Tunisia. The "Mini-Mental State Examination", "Geriatric Depression Scale", "Activity of Daily Living", "Cumulative Illness Rating Scale-Geriatric", "Death Obsession Scale", "Brief Religious Coping Scale" and "Arabic Religiosity Scale" were used to assess cognitive functions, depression, level of dependency, comorbidities, death obsession, religious coping, and religiosity, respectively. RESULTS: We found relatively high death obsession scores, with no gender differences (mean scores = 33.1 ± 18.1). Death obsession was significantly and positively associated with comorbidity scores (p = 0.04). No significant correlation was found between death obsession scores and religiosity and religious coping scores based on the bivariate analysis. Similarly, multiple hierarchical regression revealed that religious variables (overall religiosity and religious coping) did not significantly contribute to variance in death obsession. CONCLUSION: Older people living in nursing homes have specific psychosocial and spiritual needs which health care providers should recognise, assess and treat appropriately, at an early stage.

Respect, Interaction, and Immediacy: Addressing the Challenges Associated With the Different Religious and Cultural Approaches to Organ Donation in Australia.

Australia is a multicultural society of just over 25 million people, with approximately 310 different ancestries, 300 languages, and 150 religions. This diversity suggests that Australia's people might hold a multiplicity of beliefs regarding organ donation. Research shows that most people in Australia have a strong, positive perception of organ donation; they believe that organ donation helps others and benefits society. However, the current rate of 21.6 donors per million population is below expectations and below the demand for organs needed for transplantation. This has led us to ask whether donation consent rates are differentiated by religious and cultural affiliation. We present a case study of New South Wales, Australia, to address this issue. New South Wales is the most populous state in Australia and is also religiously and culturally diverse. Donation consent data (2016-2019) by ethnicity and by religion show that donation consent rates have improved but not across all groups. Initiatives to increase awareness and support for organ and tissue donation among culturally and linguistically diverse and Aboriginal and Torres Strait Islander communities are discussed. Research is also presented that investigates whether registration rates on the Australian Organ Donor Register can be increased and the implications of this for increasing consent for donation. This research underscores the importance of respecting the diversity of beliefs held regarding organ donation, both positive and negative; offering all people a face-to-face interaction opportunity to consider their beliefs about organ donation, ask questions, and raise concerns without judgment; and providing people with an immediate opportunity to register their donation decision on the Australian Organ Donor Register. The challenges associated with adopting these initiatives are considered along with the role of religious and cultural leaders within the context of organ donation and registration; the unspoken concerns of cultural and religious groups are also addressed. In conclusion, we propose that the rich diversity of Australian society is more of a backdrop than a barrier to organ donation.

Palliative and end-of-life care in Egypt: overview and recommendations for improvement.

BACKGROUND: The literature on the situation of palliative and end-of-life care in the Arab and Islamic world, including Egypt, is limited and does not present a clear picture of the cultural context. This report aims to portray the palliative and end-of-life care situation in Egypt, focusing on the nursing viewpoint. First, we describe health- and illness-related cultural, religious, and ethical issues. Second, we present an overview of the healthcare and nursing system in Egypt. Third, we discuss the situation of palliative and end-of-life care, highlighting the shortcomings of existing literature. Finally, we delineate country-specific recommendations to improve the palliative and end-of-life care situation at the level of policy, education, and research. Countries with similar healthcare, cultural, legal, religious, economic, or ethical contexts may benefit from the recommendations made in this study.

Breast cancer stigma among Indonesian women: a case study of breast cancer patients.

BACKGROUND: The stigma experienced by cancer patients stems from the association of cancer with death, as cancer is the most feared disease worldwide, especially among cancer patients and their families. The stigma regarding breast cancer screening behaviour has not been critically evaluated and is poorly understood; therefore, we aimed to analyse the stigmatization of breast cancer patients in Indonesia to reduce the morbidity and mortality of breast cancer. METHODS: A qualitative study using a focus group discussion (FGD) and in-depth interviews with thematic analysis was conducted. RESULTS: One informant experienced breast pain and kept the referral letter, in which the medical doctor advised medical treatment, to herself for 3 months due to her embarrassment. A traditional healing practice known as 'kerokan', which involves scraping of the skin, and consumption of a traditional drink were used by most informants to decrease their breast pain. Finally, most informants were diagnosed with an advanced stage of cancer when they returned to the health care facility. In addition, financial difficulties were noted as barriers to breast cancer screening in Indonesia. CONCLUSIONS: Feelings of fear and shame when diagnosed with breast cancer were reported by the informants in this study. Alternative treatment known as 'kerokan' was the first treatment sought for breast cancer symptoms due to financial difficulties among breast cancer patients. Informants were diagnosed with an advanced stage of cancer after they returned to the health care facility. A better understanding of early breast cancer symptoms could motivate women to seek out breast cancer treatment.

Requests for futile treatments: what mechanisms play a role? Results of a qualitative study among Dutch physicians.

OBJECTIVES: Overtreatment is increasingly seen as a challenge in clinical practice and can lead to unnecessary interventions, poor healthcare outcomes and increasing costs. However, little is known as to what exactly causes overtreatment. In 2015, the Royal Dutch Medical Association (RDMA) attempted to address this problem and distinguished several mechanisms that were thought to drive overtreatment. In 14 qualitative interviews among Dutch physicians, we investigated which mechanisms played a role in decision-making and whether all mechanisms were considered equally important. DESIGN: We asked physicians to present a case from personal experience, in which the patient or family requested continuing treatment against the advice of the physician. PARTICIPANTS: Fourteen physicians from five different medical areas agreed to participate. SETTING: Interviews were held face-to-face at the workplace of the physician. RESULTS: Three closely related mechanisms were mentioned most frequently as drivers of overtreatment, as perceived by the physician: 'death is not a common topic of conversation', ''never give up' is the default attitude in our society' and 'patients' culture and outlook on life influences their perception of death'. The mechanism 'medical view taking priority' was mentioned to be an inhibitor of overtreatment. CONCLUSIONS: Of the 15 mechanisms described by the report of the Steering Committee of the RDMA, not all mechanisms were mentioned as driving overtreatment. Three mechanisms were mentioned most as being a driver of overtreatment ('death is not a common topic of conversation'; ''never give up' is the default attitude in our society'' and 'patients' culture and outlook on life influences their perception of death'), some played no role at all, and others were considered to be inhibitors of overtreatment, especially the mechanism 'medical view taking priority'.

[The relationship between death obsession and religiosity in Muslim nursing home non-demented residents in Tunisia]. / Relation entre obsession de la mort et religiosité chez les résidents musulmans sans syndrome démentiel vivant en institution gériatrique en Tunisie.

BACKGROUND: The death distress would be one of the most important problems in the older population and would be more pronounced in some vulnerable older subjects, including those living in nursing homes facilities. We aimed to assess death obsession (DO) in elderly without dementia living in nursing homes, and to examine the association between DO and religiosity. METHODS: We carried out a cross-sectional survey involving 42 old subjects living in Manouba nursing home. The "Mini-Mental State Examination", the "Geriatric Depression Scale", the "Activity of Daily Living", the "Cumulative Illness Rating Scale-Geriatric", the "Death Obsession Scale", the "Brief religious coping scale" and the "Arabic Religiosity Scale" were used to assess cognitive functions, depression, level of dependency, comorbidities, death obsession, religious coping and religiosity, respectively. RESULTS: We found relatively high death obsession scores, with no gender differencies (mean scores = 33.1 ± 18.1). The death obsession was significantly and positively associated with comorbidity scores (p = 0.04). No significant correlation was found between death obsession scores and religiosity and religious coping scores in the bivariate analysis. Similarly, multiple hierarchical regression found that religious variables (global religiosity and religious coping) did not significantly contribute to the variance of the death obsession. CONCLUSION: Older people living in nursing homes have specific psychosocial and spiritual needs, that health care providors should recognize, assess and care for, early and adequately.

Cultural practices of the Zulu ethnic group on the body and their influence on body donation.

Cultural practices in the African continent have been thought to impact negatively on body donation. Thus, most African countries continue to rely on unclaimed bodies for dissection programs, or bequests from the white population. The latter situation is dominant in South African medical schools. Since South Africa is multi-cultural with nine main ethnic groups of the Black African population, it is important to seek the reasons behind lack of participation in body donation. This report represents a move in this direction with its qualitative study of the cultural practices of the Zulu ethnic group in the province of KwaZulu-Natal from the perspective of a variety of participants, with emphasis on their treatment of the human body after death. Four themes emerged from interviews: (1) Death is not the end; (2) Effect of belief in ancestors; (3) Significance of rituals and customs carried out on human tissue; and (4) Burial as the only method of body disposal. Each of these themes is discussed in relation to the likelihood of body donation being seen by Zulus as an acceptable practice. It is concluded that this is unlikely, on account of the need to preserve the linkage between the physical human body and the spirit of the deceased person, and the perceived ongoing relationship between the spirit of the dead and the living. In view of these conclusions, a number of options are canvassed about the manner in which anatomists in KwaZulu-Natal might obtain bodies for dissection. These possibilities have implications for anatomists working in comparable cultural contexts.

Religiosity and Death Anxiety: A Study of Muslim Dars Attendees.

Dars is usually considered a religious lecture or activity where attendees spend much time in search of Islamic information, which often keeps the attendees away from negative thinking. Religious directions, belief salience, spiritual activities and practices are significant assets for dealing with difficult situations and odds of life. Death anxiety can increase the vulnerability of development of any psychological illness. Therefore, it is vital to study whether religiosity can serve as a buffering agent to death anxiety. The objective of our study was to examine the relationship between religiosity and death anxiety among Muslim dars attendees. We also aimed to investigate the gender-based differences in religiosity and death anxiety among Muslim dars attendees. A purposive sample of 200 adults (male n = 100 and female n = 100) with the age range of 20-60 years participated in the present study. The sample was collected from informal religious gatherings (dars) from Islamabad and Rawalpindi. The information was gathered through self-reporting questionnaires, death anxiety scale and index of religiosity. The questionnaires were in Urdu (native language) for ease and convenience of the respondents. Variable correlation analysis and t test was applied statistically through SPSS 21 version. The findings of the study indicate that there is a significant negative relationship between religiosity and death anxiety. Results also revealed that there is insignificant difference in religiosity between male and female Muslim adults. Results also specified that the level of death anxiety is higher in female than in male Muslim adults. Religiosity has a significant inverse relationship with death anxiety, and this can be helpful in reducing the anxiety-related features. Being a trans-diagnostic construct, measures can be taken to control death anxiety in order to enhance the mental well-being of masses. The present research also puts forward that the development of religious beliefs and interventions can help people to better adjust in life.

Does the mortality salience effect on worldview defence depend on the cultural orientation of Chinese people?

According to the terror management theory, people tend to favour their worldview and in-group members after being reminded of death (i.e., mortality salience [MS] effect). However, inconsistent findings of the MS effect were found among Chinese people. In the present study, we examined the MS effect with Chinese samples and tested whether the effect would depend on participants' cultural orientation and relational self-esteem. In Studies 1 (N = 227) and 2 (N = 221), we examined the roles of participants' cultural orientations and relational self-esteem in their evaluations on moral transgression and/or perceived regard from people around after being primed with mortality (vs. dental pain) salience. We obtained the interaction effects of mortality salience, cultural orientations, and relational self-esteem. The implications of these results are discussed in the context of Chinese culture.

Embracing Death: Mexican Parent and Child Perspectives on Death.

A mixed-method approach was used to explore parent and child perspectives on death in Mexico. Parents' and children's death-related experiences and understanding of death were examined. While all children in this sample displayed a biological understanding of death, older children were less likely to endorse that all living things die. Children also displayed coexistence of beliefs related to death that can be attributed to both their biological and spiritual understanding of death. We also found that older children were more likely to report that a child should feel sad following the death of a loved one. These findings highlight how cultural practices shape the development of cognitive and affective processes related to death.

Perceptions and Attitudes toward Brain Donation among the Chinese People.

Postmortem human brain donation is crucial to both anatomy education and research. The China Human Brain Banking Consortium was established recently to foster brain donation in China. The purpose of this study was to gain information about the public perception of and attitudes toward brain donation and to identify factors that may impact the willingness to participate in brain donation among the Chinese people. A specifically designed questionnaire was delivered to community residents in Changsha (the capital city of Hunan province) with a total of 1,249 completed forms returned and statistically analyzed. The majority of the participants considered that brain donation would help medical research and education, and 32.0% of respondents agreed that the brain donation would help change the traditional Chinese funeral belief in keeping the body intact after death. However, participants aged over 60 years old were less supportive of this concept. Among all participants, 63.7% stated that they were not knowledgeable about brain donation, while 26.4% explicitly expressed a willingness to participate in brain donation. Age, gender, monthly household income, and knowledge about brain donation significantly affected the willingness. Compared with other age groups, a higher proportion of participants aged over 60 years old preferred to be informed by a medical college. To promote brain donation in China, especially among the elderly, better communication of its medical benefits and a reinterpretation of the Confucius view of the human body should be provided. Efforts are also needed to provide appropriate forums and sources of brain donation information to targeted communities and society in general.

An expressive-arts-based life-death education program for the elderly: A qualitative study.

This study endeavors to investigate how healthcare workers, equipped with expressive arts methods, could foster life-death education for the elderly. Forty-nine older adults aged 60 or above joined a 10-session expressive arts-based life-death education program that was led by social workers equipped with expressive arts methods. An ethnographic research approach, with a post-treatment focus group (n = 17), was conducted with the participants. The results showed that expressive arts methods could enhance reorganization of life experiences, promote dealing with ambivalent emotion regarding life-death issues, improve communicating life-death issues with family members, and induce ideas to prepare for death.

Societal Reactions to Suicide in Ghana.

Background: Condemnatory reactions toward suicide are prevalent in Africa, yet no study has examined how society reacts to suicides from the perspective of suicide-bereaved persons. Aims: This qualitative study explored societal reactions to suicides so as to further our understanding of the problem in Ghana. Method: Using a semi-structured interview guide, we interviewed 45 close relations of 14 men who took their lives. Results: The reactions followed ontological questions of what suicide means (construing the act), its impact (consequences), why it happened and who to blame (attributions and allocation of responsibility), and how to remedy perceived damages (damage control). Limitations: Focusing on suicides of only men might have limited the range of societal reactions to suicide in general. Conclusion: Reparative and retributive societal reactions to suicides were influenced predominantly by views that suicide is an extraordinary moral evil in the setting. Increased culturally focused suicide education can improve people's understanding and enhance responsive suicide prevention and postvention.

Reincarnation beliefs among Israeli Druze and the construction of a hard primordial identity.

Most of the literature on reincarnation among the Druze attempts to shed light on its history and on those who believe in it. In this paper, we will argue that the Druze's belief in reincarnation serves as one of the central components in defining their ethno-religious identity. Our study is based on an analysis of 30 semi-structured interviews with Israeli Druze university students. Findings suggest that the belief in reincarnation plays an important role in the lives of the Druze and it appears to serve as the most outstanding component in the young Druze' definition of their primordial identity.

Japanese young adults' attitudes toward suicide and its influencing factors.

This study investigated young Japanese adults' attitudes toward suicide and factors affecting them. Results revealed that 28.78% of respondents had serious suicidal ideation history; 18.53% knew suicidal others; and 15.29% took suicide-prevention training. A t-test showed that respondents' "Right to suicide" and "Common occurrence" scores were higher with suicidal ideation history, but "Unjustified behavior" was lower than in those without history. Results indicated that certain young adults were unsupportive by being permissive of suicide due to their suicidal ideation or becoming bystanders due to inexperience. For young Japanese adults, enhancing preventive education to alter permissive/bystander attitudes is crucial.

Medically Timed Death as an Enactment of Good Death: An Ethnographic Study of Three European Intensive Care Units.

The article is based on ethnographic observation and semistructured interviews with personnel in three European adult intensive care units. Intensive care is a domain of contemporary biomedicine centered on invasive and intense efforts to save lives in acute, critical conditions. It echoes our culture's values of longevity. Nevertheless, mortality rates are elevated. Many deaths follow from nontreatment decisions. Medicalized dying in technological medical settings are often presented as unnatural, impersonal, and undesirable ways of dying. How does this affect the way in which death is experienced by intensive care professionals? What might the enactment of dying in intensive care reveal about our cultural values of good and bad dying?