Death and Dying Between Anthroposophy and Biomedicine / A morte e o morrer entre a antroposofia e a biomedicina

Abstract Death and dying constantly provoke debates regarding boundaries, rules and disputes for the legitimacy of different meanings regarding processes of finalizing life. This article places special emphasis on conflicts between the therapeutic system of anthroposophy and biomedicine in Brazil. The reflections contained in the text are based on ethnographic research, carried out in multiple locations between 2012 and 2015, investigating concepts of cure in anthroposophy in three different communities: two in Brazil, and one in Switzerland. Over the course of this journey, our experience as ethnographers led us to reflect on death and dying among the Widows of Demétria, one of the anthroposophical communities in which we conducted our research. Demétria is a rural neighborhood located in the city of Botucatu, in the interior of São Paulo state. The community was first organized during the 1970s, and it consists mostly of women - both Europeans and Brazilians - who live together, sharing a lifestyle that reimagines the ethos of death as a part of the aesthetic project of Bildung, which differs significantly from the conception of the death process in biomedicine.

Resumo A morte e o morrer suscitam continuamente o debate sobre as fronteiras, as regras e a disputa pela legitimidade dos distintos significados que envolvem os processos de finalização da vida. Este artigo busca abordar, especialmente, os conflitos que ocorrem entre o sistema terapêutico antroposófico e a biomedicina no Brasil. As reflexões se dão com base na etnografia multissituada realizada entre os anos 2012 e 2016 que se debruçou sobre a concepção de cura na antroposofia em três comunidades, duas no Brasil e uma na Suíça. Nesse percurso, fomos levados pela experiência etnográfica às elaborações sobre a morte e o morrer das viúvas da Demétria, uma das comunidades antroposóficas investigadas. Demétria é um bairro rural no interior do estado de São Paulo, na cidade de Botucatu, composto na sua maioria por mulheres, europeias e brasileiras, que convivem e partilham de um estilo de vida que reelabora o ethos da morte como um projeto estético de Bildung que difere da concepção do processo de morte na biomedicina.

Brain activity underlying American crow processing of encounters with dead conspecifics.

Animals utilize a variety of auditory and visual cues to navigate the landscape of fear. For some species, including corvids, dead conspecifics appear to act as one such visual cue of danger, and prompt alarm calling by attending conspecifics. Which brain regions mediate responses to dead conspecifics, and how this compares to other threats, has so far only been speculative. Using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) we contrast the metabolic response to visual and auditory cues associated with a dead conspecific among five a priori selected regions in the American crow (Corvus brachyrhynchos) brain: the hippocampus, nidopallium caudolaterale, striatum, amygdala, and the septum. Using a repeated-measures, fully balanced approach, we exposed crows to four stimuli: a dead conspecific, a dead song sparrow (Melospiza melodia), conspecific alarm calls given in response to a dead crow, and conspecific food begging calls. We find that in response to observations of a dead crow, crows show significant activity in areas associated with higher-order decision-making (NCL), but not in areas associated with social behaviors or fear learning. We do not find strong differences in activation between hearing alarm calls and food begging calls; both activate the NCL. Lastly, repeated exposures to negative stimuli had a marginal effect on later increasing the subjects' brain activity in response to control stimuli, suggesting that crows might quickly learn from negative experiences.

Physicians' knowledge about patients' religious beliefs in pediatric care / O conhecimento médico a respeito das diversas religiões nos cuidados pediátricos

ABSTRACT Objective: To describe the knowledge of pediatricians and pediatric residents about the meaning of death according to the most prevalent religions in Brazil. Methods: A cross-sectional survey was conducted among pediatricians and pediatric residents at a tertiary-level children's hospital in the city of São Paulo, SP, Brazil, questioning about their knowledge and experience related to spiritual care and the most common religious beliefs among pediatric palliative care patients in Brazil. Results: 116 physicians answered the questionnaire, 98 (84.5%) considered themselves religious, defined as followers of any spiritual creed around the world, and 18 (15.5%) non-religious. Of the total, 97 (83.6%) considered themselves capable of dealing with the spiritual care of Catholic patients, 49 (42.2%) of Protestant patients and 92 (79.3%) of patients that follow Spiritism in the process of death. Religious doctors used less chaplaincy services than non-religious doctors (relative risk - RR 2.54; p=0.0432; confidence interval of 95% - 95%CI 1.21-5.34). Among the physicians, 111 (96%) believe that spirituality is beneficial in accepting the death process, responses were associated with the religiosity of the physicians (RR 1.18; p=0.0261; 95%CI 0.95-1.45). Also, 106 (91.4%) are unaware of the religion of their patients and the same number of participants consider pediatricians, in general, unprepared to deal with the spiritual aspect of death. These data are not associated with the participants' religiosity. Conclusions: Although most pediatricians and residents consider themselves able to deal with the most prevalent religions in Brazil and affirm that spirituality is beneficial during the death process, little importance is given to the spiritual identity of their patients, which could limit an appropriate approach to their death process.

RESUMO Objetivo: Descrever o conhecimento dos médicos pediatras e residentes de pediatria a respeito do significado da morte segundo as religiões mais prevalentes no Brasil. Métodos: Estudo transversal em que foi aplicado um questionário aos médicos pediatras e residentes de um hospital pediátrico de nível terciário da cidade de São Paulo, SP, Brasil, sobre o conhecimento e as experiências acerca de religiões de pacientes paliativos. Resultados: Ao todo, 116 médicos responderam ao questionário, 98 (84,5%) religiosos, definidos como seguidores de algum dogma espiritual existente no mundo, e 18 (15,5%) não religiosos. Do total, 97 (83,6%) considera-se apto a lidar com os cuidados espirituais de pacientes católicos, 49 (42,2%) de pacientes protestantes e 92 (79,3%) de pacientes espíritas em processo de morte. Médicos religiosos utilizaram menos os serviços de capelania do que médicos não-religiosos (risco relativo - RR 2,54; p=0,043; intervalo de confiança de 95% - IC95% 1,21-5,34). Dos entrevistados, 111 (96%) acreditam que a espiritualidade é benéfica na aceitação do processo de morte, resposta associada à religiosidade dos médicos (RR 1,18; p=0,026; IC95% 0,95-1,45). Ainda, 106 (91,4%) dos entrevistados desconhecem a religião de seus pacientes. A mesma quantidade de participantes considera os pediatras, em geral, despreparados para lidar com o aspecto espiritual da morte, e esses dados não estão ligados à manifestação de religiosidade. Conclusões: Apesar de a maioria dos médicos pediatras e residentes se dizer apta a lidar com as religiões mais prevalentes no Brasil e afirmar que a espiritualidade é benéfica durante o processo de morte, pouca importância é dada à identidade espiritual de seus pacientes, o que pode dificultar uma abordagem adequada ao seu processo de morte.

PHYSICIANS' KNOWLEDGE ABOUT PATIENTS' RELIGIOUS BELIEFS IN PEDIATRIC CARE.

OBJECTIVE: To describe the knowledge of pediatricians and pediatric residents about the meaning of death according to the most prevalent religions in Brazil. METHODS: A cross-sectional survey was conducted among pediatricians and pediatric residents at a tertiary-level children's hospital in the city of São Paulo, SP, Brazil, questioning about their knowledge and experience related to spiritual care and the most common religious beliefs among pediatric palliative care patients in Brazil. RESULTS: 116 physicians answered the questionnaire, 98 (84.5%) considered themselves religious, defined as followers of any spiritual creed around the world, and 18 (15.5%) non-religious. Of the total, 97 (83.6%) considered themselves capable of dealing with the spiritual care of Catholic patients, 49 (42.2%) of Protestant patients and 92 (79.3%) of patients that follow Spiritism in the process of death. Religious doctors used less chaplaincy services than non-religious doctors (relative risk - RR 2.54; p=0.0432; confidence interval of 95% - 95%CI 1.21-5.34). Among the physicians, 111 (96%) believe that spirituality is beneficial in accepting the death process, responses were associated with the religiosity of the physicians (RR 1.18; p=0.0261; 95%CI 0.95-1.45). Also, 106 (91.4%) are unaware of the religion of their patients and the same number of participants consider pediatricians, in general, unprepared to deal with the spiritual aspect of death. These data are not associated with the participants' religiosity. CONCLUSIONS: Although most pediatricians and residents consider themselves able to deal with the most prevalent religions in Brazil and affirm that spirituality is beneficial during the death process, little importance is given to the spiritual identity of their patients, which could limit an appropriate approach to their death process.

Produção científica sobre as contribuições fenomenológicas para o estudo da tanatologia na enfermagem / Producción científica sobre las contribuciones fenomenológicas para el estudio de la tanatología en enfermería / Scientific Production about Phenomenological Contributions for the Study of Thanatology in Nursing

RESUMO Introdução: A intervenção do cuidado passa diretamente pela compreensão, reflexão, analise de como o profissional da enfermagem percebe o fenômeno do processo de morte/morrer. Objetivo: Analisar as produções científicas desenvolvidas pela enfermagem que abordam a temática tanatologia. Métodos: Estudo de revisão integrativa, de característica crítica e retrospectiva. Estratégia de busca: utilização da palavra-chave "fenomenologia" e descritores "enfermagem", "cuidados paliativos" e "tanatologia". A busca ocorreu nas bases: MEDLINE; LILACS; BDENF e SCOPUS. Critérios de inclusão: artigos disponibilizados na íntegra nos portais de dados selecionados que apresentavam aderência à temática em Português, Inglês e Espanhol, publicados entre os anos de 2011 a 2015 e que apresentassem na metodologia o referencial filosófico adotado. Critérios de exclusão: pesquisas que se encontravam repetidas nas bases de dados. Conclusões: Abordam o processo morte/morrer por acadêmicos ingressantes no curso de enfermagem; a vivencia da terminalidade por intermédio da arte; o cuidado paliativo na terminalidade e a doação de órgãos após a finitude da vida. A preocupação pela temática permeia o cenário acadêmico e hospitalar, mas em ambos a preocupação mais latente está ligada a humanização assistencial. As produções científicas desenvolvidas pela enfermagem que abordam a temática tanatologia presam pelo cuidado não apenas durante o processo morte/morrer, mas estende-se ao pós-morte por meio da doação de órgãos, o que demonstra um olhar holístico ao exercer o cuidar, tornando este efetivo e com repercussões positivas sobre a memória dos que recebem os cuidados(AU)

RESUMEN Introducción: La intervención de cuidado pasa directamente por la comprensión, la reflexión, el análisis de la forma en que el profesional de enfermería percibe el fenómeno del proceso de la muerte / morir. Objetivo: Analizar las publicaciones científicas que abordan el tema de la Tanatología desarrolladas por la enfermería. Métodos: Estudio de revisión integradora de la función crítica y retrospectiva, con fuentes de datos primarios. Estrategia de búsqueda: el uso de palabras clave "fenomenología" y descriptores "enfermería" y "cuidados paliativos". La búsqueda se produjo en: MEDLINE; LILACS; BDENF y SCOPUS. Criterios de inclusión: los artículos disponibles en su totalidad en los portales de datos seleccionados que presentan la adherencia al tema en portugués, inglés y español, publicados entre los años 2011 la 2015 y para proporcionar el marco filosófico metodología adoptada. Criterios de exclusión: investigaciones que se repitieron en las bases de datos. Conclusiones: Se acercan a la muerte / proceso de morir por los estudiantes de primer año en el programa de enfermería; las experiencias de enfermedad terminal a través del arte; cuidados paliativos de la enfermedad terminal y la donación de órganos después de la finitud de la vida. La preocupación por el tema impregna el entorno académico y el hospital, pero en tanto la preocupación más latente está vinculada a la humanización del cuidado. Producciones científicas desarrolladas por la enfermería abordan la cuestión de la Tanatología fundamentalmente la atención no solo durante el proceso de la muerte, sino que se extiende a la otra vida con el tema de la donación de órganos, lo que demuestra una mirada integral al cuidado de ejercicio haciendo este eficaz y positivo en la memoria de los que reciben atención(AU)

ABSTRACT Introduction: Health care passes directly through understanding, reflection, and analysis of the way the nursing professional perceives the phenomenon of death or dying. Objective: To analyze the scientific publications addressing the topic of thanatology as developed by nursing. Methods: Integrative review study of the critical and retrospective function, with primary data sources. The search strategy consisted in the use of the keywords and descriptors fenomenología [phenomenology],enfermería [nursing] and cuidados paliativos [palliative care]. The search was performed MEDLINE, LILACS, BDENF and SCOPUS. The inclusion criteria permitted to choose the articles totally available in the selected sites and presenting relation to the topic in Portuguese, English and Spanish, published between 2011 and 2015 and those providing the philosophical framework adopted. The exclusion permitted not to use the investigations that were repeated in the databases. Conclusions: First-year students of the nursing program approach death or the dying process, the experiences associated with terminal illness through art, palliative care for terminal illness and organ donation after the finiteness of life. Concern about the topic permeates the academic environment and the hospital, but the most representative concern is associated with the care humanization. Scientific productions developed by nurses address the topic of thanatology, mainly the attention not only during the process of death, but extended to the next life with the focus of organ donation, which demonstrates a comprehensive approach to healthcare, being this effective and positive in the memory of those who receive attention(AU)

The integrated motivational-volitional model of suicidal behaviour.

Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational-volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.This article is part of the theme issue 'Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.

Changing relationship between the dead and the living in Japanese prehistory.

The aim of this paper is to propose a new insight on the changing burial practice by regarding it as a part of the cognitive system for maintaining complex social relationships. Development of concentrated burials and their transformation in Japanese prehistory are examined to present a specific case of the changing relationship between the dead and the living to highlight the significance of the dead in sociocultural evolution. The essential feature of the burial practices observed at Jomon sites is the centrality of the dead and their continuous presence in the kinship system. The mortuary practices discussed in this paper represent a close relationship between the dead and the living in the non-hierarchical complex society, in which the dead were not detached from the society, but kept at its core, as a materialized reference of kin networks.This article is part of the theme issue 'Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.

Produção científica sobre as contribuições fenomenológicas para o estudo da Tanatologia na enfermagem / Producción científica sobre las contribuciones fenomenológicas de enfermería para el estudio de la Tanatología / Scientific production on the contributions infirmary fenomenológicas for the study of the Tanatología

RESUMO Introdução: a intervenção do cuidado passa diretamente pela compreensão, reflexão, analise de como o profissional da enfermagem percebe o fenômeno do processo de morte/morrer. Objetivo: analisar as produções científicas desenvolvidas pela enfermagem que abordam a temática tanatologia. Métodos: estudo de revisão integrativa, de característica crítica e retrospectiva. Estratégia de busca: utilização da palavra-chave "fenomenologia" e descritores "enfermagem", "cuidados paliativos" e "tanatologia". A busca ocorreu nas bases: MEDLINE; LILACS; BDENF e SCOPUS. Critérios de inclusão: artigos disponibilizados na íntegra nos portais de dados selecionados que apresentavam aderência à temática em Português, Inglês e Espanhol, publicados entre os anos de 2011 a 2015 e que apresentassem na metodologia o referencial filosófico adotado. Critérios de exclusão: pesquisas que se encontravam repetidas nas bases de dados. Conclusões: abordam o processo morte/morrer por acadêmicos ingressantes no curso de enfermagem; a vivencia da terminalidade por intermédio da arte; o cuidado paliativo na terminalidade e a doação de órgãos após a finitude da vida. A preocupação pela temática permeia o cenário acadêmico e hospitalar, mas em ambos a preocupação mais latente está ligada a humanização assistencial. As produções científicas desenvolvidas pela enfermagem que abordam a temática tanatologia presam pelo cuidado não apenas durante o processo morte/morrer, mas estende-se ao pós-morte por meio da doação de órgãos, o que demonstra um olhar holístico ao exercer o cuidar, tornando este efetivo e com repercussões positivas sobre a memória dos que recebem os cuidados(AU)

RESUMEN Introducción: la intervención de cuidado pasa directamente por la comprensión, la reflexión, el análisis de la forma en que el profesional de enfermería percibe el fenómeno del proceso de la muerte / morir. Objetivo: analizar las publicaciones científicas que abordan el tema de la Tanatología desarrolladas por la enfermería. Métodos: estudio de revisión integradora de la función crítica y retrospectiva, con fuentes de datos primarios. Estrategia de búsqueda: el uso de palabras clave "fenomenología" y descriptores "enfermería" y "cuidados paliativos". La búsqueda se produjo en: MEDLINE; LILACS; BDENF y SCOPUS. Criterios de inclusión: los artículos disponibles en su totalidad en los portales de datos seleccionados que presentan la adherencia al tema en portugués, inglés y español, publicados entre los años 2011 la 2015 y para proporcionar el marco filosófico metodología adoptada. Criterios de exclusión: investigaciones que se repitieron en las bases de datos. Conclusiones: se acercan a la muerte / proceso de morir por los estudiantes de primer año en el programa de enfermería; las experiencias de enfermedad terminal a través del arte; cuidados paliativos de la enfermedad terminal y la donación de órganos después de la finitud de la vida. La preocupación por el tema impregna el entorno académico y el hospital, pero en tanto la preocupación más latente está vinculada a la humanización del cuidado. Producciones científicas desarrolladas por la enfermería abordan la cuestión de la Tanatología fundamentalmente la atención no solo durante el proceso de la muerte, sino que se extiende a la otra vida con el tema de la donación de órganos, lo que demuestra una mirada integral al cuidado de ejercicio haciendo este eficaz y positivo en la memoria de los que reciben atención(AU)

ABSTRACT Introduction: care intervention passes directly by the understanding, reflection, analysis of how the nursing professional perceives the phenomenon of the process of death / die. Objective: analyze the scientific publications that address the issue of thanatology developed by nursing. Methods: study of integrative review of critical feature and retrospective, with primary data sources. Search strategy: keyword use "phenomenology" and descriptors "nursing" and "palliative care". The search occurred in: MEDLINE; LILACS; BDENF and SCOPUS. Inclusion criteria: articles available in full on the selected data portals presenting adherence to the theme in Portuguese, English and Spanish, published between the years 2011-2015 and to provide the methodology philosophical framework adopted. Exclusion criteria: researches which were repeated in the databases. Conclusion: approach the process death / die for entering students in the nursing program; the experiences of terminality through art; palliative care in terminality and organ donation after the finiteness of life. Concern for the thematic permeates the academic and hospital setting, but in both the most latent concern is linked to care humanization. Scientific productions developed by nursing addressing the issue of Thanatology presam the care not only during the process death / die, but extend to the afterlife with the issue of organ donation, which demonstrates a holistic look at exercise care making this effective and positive effect on the memory of those who receive care(AU)

Aspectos bioéticos desde la visión personalista de la espiritualidad en el manejo de las personas en el área de la salud / Bioethical aspects from the personalist vision of spirituality in the management of people in the health area

Introducción: Por regla general todos los trabajadores de la salud han sido modelados por el paradigma científico de la modernidad que ha hecho una separación drástica entre cuerpo y mente y entre ser humano y naturaleza. Pero porque no se ha considerado en el abordaje de la espiritualidad en paciente sanos o con patologías que no necesariamente amenazan la vida? Esta interrogante debe darse respuesta tanto desde el punto de vista holístico y como parte de la ética del cuidado. No se puede separar al ser humano al cuidarlo solo en lo biológico o psicológico, el aspecto espiritual ha de ser abordado. Objetivos: Determinar qué aspectos de la Bioética están relacionados con la espiritualidad en el manejo de los pacientes. Paciente y Métodos: estudio cualitativo mediante Revisión sistemática de la literatura médica publicada en los siguientes buscadores: scielo, HINARI, pubmed, revisión de artículos publicados y manuales de Bioética y Espiritualidad, revisión de publicaciones en congreso, conferencias sobre Bioética y Espiritualidad. Resultados: El número total de artículos identificados fue de 101 (MEDLINE) y 135 (CINAHL). Después de tamizar, la recopilación de otros artículos que hablan sobre un aspecto de la espiritualidad, pero no el término en sí mismo (por ejemplo, la esperanza); la realización de búsquedas manuales en bibliografías o referido por sus compañeros que no se encuentran en la búsqueda de la literatura original, 58 artículos se consideraron pertinentes y se discuten aquí en el análisis temático. Los investigadores, que se sitúan en este campo, inevitablemente sugieren estudiar la espiritualidad desde una perspectiva más cualitativa, con el argumento de que porque la espiritualidad ha de ser experimentado que no se puede medir. Las palabras de McGrath encarnan la idea central de esta perspectiva, "conceptualmente, la espiritualidad no puede ser entendido como una entidad independiente que se mide y se registra. Los investigadores tienen que estar abiertos a la gran cantidad de formas en que los individuos construyen significado". Las necesidades espirituales de los pacientes de cuidados paliativos la naturaleza de la esperanza en los cuidados paliativos; herramientas y terapias relacionadas con la espiritualidad; efectos de la religión en los cuidados paliativos; y la espiritualidad y los profesionales de cuidados paliativos. En otros estudios se han informado que la espiritualidad y aspectos relacionados (por ejemplo, la oración, la meditación) han tenido un efecto positivo en: dolor crónico; psoriasis en pacientes que reciben fototerapia; función inmune; menos efectos adversos en pacientes cardíacos; mayor apoyo social y menos síntomas depresivos entre los pacientes geriátricos; aumento de la salud física y mental. Conclusión: existen evidencias para nada despreciables de que la espiritualidad tiene relación con el estado de salud y calidad de vida de las personas, que explorarlas, trabajarlas produce un bien en el ser persona del paciente, visto en su totalidad como ser digno en cualquier circunstancia, por tanto es ético tener que abordarlo adecuadamente

Introduction: As a general rule all health workers have been modeled by the scientific paradigm of modernity that has made a drastic separation between body and mind and between human and nature. But because it has not been considered in the approach of spirituality in healthy patients or with pathologies that do not necessarily threaten life? This question must be answered both holistically and as part of the ethics of care. It is not possible to separate the human being by taking care of it only in the biological or psychological, the spiritual aspect has to be approached. Objectives: To determine which aspects of bioethics are related to spirituality in the management of patients. Patient and Methods: qualitative study through Systematic Review of medical literature published in the following search engines: scielo, HINARI, pubmed, review of published articles and manuals Of Bioethics and Spirituality, review of publications in congress, conferences on Bioethics and Spirituality. Results: The total number of articles identified was 101 (MEDLINE) and 135 (CINAHL). After sifting, the compilation of other articles that speak about an aspect of spirituality, but not the term itself (eg, hope); The accomplishment of manual searches in bibliographies or referred by his companions that are not in the search of the original literature, 58 articles were considered pertinent and are discussed here in the thematic analysis. Researchers, who are in this field, inevitably suggest studying spirituality from a more qualitative perspective, arguing that because spirituality has to be experienced it can not be measured. McGrath's words embody the central idea of this perspective, "conceptually, spirituality can not be understood as an independent entity that is measured and recorded "Researchers have to be open to the myriad ways in which individuals construct meaning" the spiritual needs of palliative care patients the nature of hope in palliative care; Tools and therapies related to spirituality; Effects of religion on palliative care; And spirituality and palliative care professionals. Other studies have reported that spirituality and related aspects (eg, prayer, meditation) have had a positive effect on: chronic pain; Psoriasis in patients receiving phototherapy; Immune function; Fewer adverse effects in cardiac patients; Greater social support and fewer depressive symptoms among geriatric patients; Increased physical and mental health. Conclusion: there is no evidence that spirituality is related to the health and quality of life of people, to explore them, to work them produces a good in the person of the patient, seen in its totality as being worthy in any circumstance, So it is ethical to have to address it properly.

Atención tanatológica para mejorar el bienestar espiritual de los pacientes hospitalizados con quemaduras / Thanatology care to improve spiritual well-being of hospitalized patients with burns

Resumen:

Objetivo: evaluar el efecto de la atención tanatológica en pacientes con quemaduras, a través de la escala de bienestar espiritual FACIT-Spl2.

Metodología: el estudio se realizó en pacientes con quemaduras de diversos grados. Se recolectaron datos sociodemográficos y a los pacientes se les aplicó la encuesta FACIT-Spl2 para evaluar su bienestar espiritual al inicio y al final de su estancia hospitalaria. Se les proporcionó atención de tanatología durante todo el periodo de hospitalización. El análisis incluyó estadística descriptiva y no paramétrica.

Resultados: se seleccionaron 107 pacientes que obtuvieron un promedio de 35.7 puntos en la encuesta FACIT-Spl2 aplicada al inicio. La puntuación aumentó a 40.7 al final del tratamiento hospitalario, lo que nos indica una mejoría en el bienestar espiritual de los pacientes, puesto que la diferencia fue estadísticamente significativa (Z = -6.53, p = 0.000).

Conclusiones: la atención tanatológica debe incluirse en el tratamiento integral proporcionado a pacientes con quemaduras, ya que demostró que mejoraba su bienestar espiritual, influyendo positivamente en su recuperación durante su estancia hospitalaria.

Abstract:

Objective: to evaluate the effect of Thanatology counseling in burn patients through the FaCIT-Spl2 spiritual well-being scale.

Methodolog: the study population comprised of hospitalized patients with several burn injuries. Socio-demographic information was collected, and participants completed the FACIT-Spl2 scale for spiritual well-being assessment the first and last day of hospital stay. Thanatology counseling was provided to them through the complete hospitalization time. Descriptive statistics was calculated for socio-demographic variables and non-parametric tests to calculate differences between obtained scores.

Results: the sample included 107 burn patients and scored 35.7 in the FACIT-Spl2 scale applied at baseline. This score increased to 40.7 at the end of treatment, which indicates an improvement in the spiritual well-being of patients and this difference was statistically significant (Z = -6.53, p = 0.000).

Conclusions: thanatology counseling should be included as part of the integral treatment given to burn patients because it has showed to improve their spiritual well-being, therefore it has a positive effect in their recovery during their hospital stay.

Hannelore Wass: Insights Into Creative Teaching and Other Ways of Knowing When Facing Aging and Mortality.

Art is about freeze framing life and making it available for contemplation. This article describes creative strategies for teaching meaning-making and critical thinking through the use of imagery and the visual arts and how they have been influenced by the wisdom and guidance of Dr. Hannelore Wass. Dr. Wass's passion for encouraging death educators to explore "other ways of knowing" is reflected in the connections between visual imagery and topics such as caregiving, aging, self-care, and professional boundaries. The group known as Women in Thanatology as a mechanism for professional mentoring and support is described, including Dr. Wass's role in its history and evolution.

A Spiritual Journey: Influence of Hannelore.

Little do we know as we go along our ordinary daily living that an invitation to listen could so profoundly affect another person's life. The gift of true listening can bring about connections and relationships that last for a lifetime. This reflective article reminds educators to take time to encourage, question, support, and challenge eager neophytes in their classes.

La terapia floral en la atención al paciente terminal y su familia / Floral therapy in the care of the terminal patient and his/her relatives

En el presente trabajo se hizo una revisión sobre el tema la asistencia al paciente terminal y su familia desde la perspectiva de la terapia floral. Se mencionó las etapas por las que atraviesa un enfermo en estadio terminal propuestas por la psiquiatra suiza Elizabeth Kübler Ross; se hizo referencia al sistema terapéutico que utiliza esencias florales, elaborado por el médico inglés Edward Bach; y se sugirieron algunas esencias que pueden resultar de utilidad en cada una de las etapas, tanto para el paciente como para su familia. También se mencionó la atención a los familiares después del fallecimiento del ser querido, en la ayuda a una mejor travesía por el duelo y una más pronta inserción a la vida. Se destacó las bondades de la terapia floral en cuanto a su efectividad y fácil aplicación, así como su falta de nocividad, su bajo costo y la creciente demanda de la población. Se realizó un análisis documental de textos clásicos sobre los temas tanatología y terapia floral(AU)

In the current work we carried out a review on the theme of the care of the terminal patient and his/her relatives from the view of the floral therapy. We mentioned the stages through which passes a terminal patient proposed by the Swiss psychiatrist Elizabeth Kübler Ross. We referred the therapeutic system using floral essences, elaborated by the English physician Edward Bach and suggested several essences that might be useful in each of the stages, both for the patient and for the relatives; we also mentioned the care to relatives after the decease of the beloved being in help for a better travel through the mourning period and for a faster reincorporation to life. We emphasized the goodness of floral therapy, with regards to its effectiveness and easy application, harmless, low cost and the increasing demand of this therapy from the part of the population. We carried out a documental analysis of classic texts on the theme of Thanatology and Floral Therapy(AU)

Efecto de la intervención tanatológica con grupos de encuentro en el paciente cardiópata y familiares durante la hospitalización / Effect of thanatological encounter groups intervention in the cardiac patient and family during hospitalization", "_i": "

Introducción: La intervención tanatológica con grupos de encuentro es una estrategia que se propone para la reeducación emocional, experimentación y autocontrol de las emociones, restableciendo la resolución de problemas. Objetivo: Determinar el efecto que tiene una intervención tanatológica en el estado emocional del paciente cardiópata y de los familiares. Material y métodos: Estudio comparativo, prospectivo y transversal. Muestra no probabilística por conveniencia (n = 309), incluyó 159 pacientes hospitalizados y 150 familiares, ambos sexos; se eliminaron participantes que llegaron tarde o interrumpieron la sesión. Previo consentimiento, contestaron antes y después de la intervención una cédula ex profeso, que valora estados emocionales con escala de respuesta: nada = 0, poco = 1 y mucho = 2. Intervención tanatológica de modalidad intensiva, con técnicas de musicoterapia, terapia de juego, expresión emotiva e imaginería. Datos analizados con frecuencias, porcentajes, media y prueba de Wilcoxon, significancia p ‹ 0.05. Resultados: En ambos grupo predominó el sexo femenino, 53% en pacientes y 66.7% en familiares: 54.4% de pacientes con edad entre 50-70 años y 73.3% de familiares entre 19-49 años. Posterior a la intervención, en los pacientes disminuyeron las emociones desagradables, considerando poco y mucho temor, confusión, cansancio y aburrimiento, y los agradables incrementaron en poco o mucho, como la alegría, seguridad, reflexión y realización; mientras que en los familiares se encontró el mismo fenómeno en las emociones agradables y desagradables, siendo un cambio estadísticamente significativo (p ‹ 0.05). Conclusión: La intervención tanatológica disminuye las emociones desagradables y aumenta las agradables. Lo anterior abre la posibilidad de que los participantes reactiven mecanismos de afrontamiento y resolución de problemas.

Introduction: Thanatological intervention group meeting is proposed for emotional re-education, experimentation and self-control of emotions strategy, restoring the capacity for problem solving. Objective: To determine the effect of a thanatological intervention in the emotional state of the cardiac patient and family. Material and methods: Comparative, prospective, cross-sectional study. Non-probability sample for convenience (n = 309) included 159 inpatients and 150 relatives both sexes; participants who arrived late or interrupted the session were removed. Previous consent, they answered before and after the intervention an intentional writ, that values emotional states with a response scale of: nothing = 0, a bit = 1 and much = 2. Thanatological intervention of intensive modality, with techniques of music therapy, play therapy, emotional expression and imagery. Data analyzed with frequency, percentage, mean and Wilcoxon test, significance p ‹ 0.05. Results: In both groups predominated female, 53% in patients and 66.7% in families: 54.4% of patients aged 50-70 years and 73.3% of families between 19-49 years. After the intervention, patients decreased unpleasant emotions, considering slight and great fear, confusion, fatigue and boredom, and increased pleasant emotions a little or a lot, such as joy, security, reflection and realization; while in the family members the same phenomenon was found in the pleasant and unpleasant emotions, being statistically significant (p ‹ 0.05). Conclusion: Thanatological intervention decreases unpleasant and increases pleasant emotions. This opens the possibility that participants reactivate coping mechanisms and problem solving capacity.

Long life, natural death. The learned ideal of dying in late medieval commentaries on Avicenna's Canon.

Within late medieval learned medicine, natural death functioned both as a theoretical concept and as a goal for practice. Late medieval commentaries on Avicenna's Canon are used as source material in this study, in order to investigate the ways in which these learned medical authors envisaged natural death. The findings are compared to descriptions of natural death by natural philosophers, and to ideals of dying in broader medieval culture. According to the physicians, natural death was caused by the extinction of innate heat, due to a lack of innate moisture. They discussed natural death in relation to regimen, as the right regimen protected the body's heat and moisture, and thus helped a patient to keep natural death aloof. So, in order to think about natural death, the physicians turned to the whole of life, during which heat dried out moisture and regimens ought to be followed. By contrast, natural philosophers tended to focus on the moment of death itself. The comparison of natural death with the Good Death in broad medieval culture highlights the amoral nature of the natural death.

Does our society have the proper understanding of death?

Recent developments in medicine in our society have drawn attention to various phenomena related to death, such as brain death, cardiac death, vegetative death, euthanasia, death with dignity, near-death experiences, hospice, and suicide. The definition and conception of death is significant because its reductionist determination may bring about a denial or taboo of death and a certain limitation on the modes of life and death. As religious traditions like Christianity and Buddhism and life and death studies show, human death cannot and should not be explained by physical and biological criterion of death like brain death or cardiac death alone. In a society with such a reductionist definition of death there can be no space for a mature culture of death and only a colossal number of miserable deaths like suicide. Therefore, as Kubler Ross argues, death should be defined in terms of considering the continued existence of certain realities as to psyche, spirit, and the meaning of life beyond physical and biological aspects. The medical and legal approach to death is greatly incomplete and restricted in taking into account the physical and biological aspect of death. Thus, it is necessary to precisely and deeply reconsider the definition and understanding of death from a broader and more comprehensive perspective rather than concentrating solely on the physical and biological criterion of death such as brain death or cardiac death.

Intervención tanatológica en la Unidad de Cuidados Integrales Avanzados para el Paciente Cardiópata del Instituto Nacional de Cardiología Ignacio Chávez / Thanatological intervention in the Advanced Comprenhensive Care Unit for cardiopathy patient of the National", "_i": "

Los cuidados paliativos (CsPs) surgen por la necesidad de ayudar al enfermo que está cercano a la muerte, por esta razón la Organización Mundial de la Salud los propuso como un componente de toda política sanitaria nacional y los define como: “El enfoque que mejora la calidad de vida de pacientes y familias que se enfrentan a los problemas asociados con enfermedades amenazantes para la vida, a través de la prevención y alivio del sufrimiento por medio de la identificación temprana e impecable evaluación y tratamiento del dolor y otros problemas, físicos, psicológicos y espirituales”. En el año 2011, el Instituto Nacional de Cardiología Ignacio Chávez presenta ante la Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, un plan de trabajo en el cual se otorgarán CsPs, cuyo nombre queda establecido como Unidad de Cuidados Integrales Avanzados para el Paciente Cardiópata y su Familia. En el presente escrito se aborda cómo está constituida esta unidad y el tipo de intervenciones tanatológicas que se realizan.

Palliative care, arise from the need to help the patient who is close to death, that is why the World Health Organization, he proposed that they should constitute a component of any national health policy and defined as The approach that improves the quality of life of patients and families facing the problems associated with disease threatening to life, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual. In 2011, the National Institute of Cardiology Ignacio Chavez presented to the Coordinating Commission of National Institutes of Health and Hospitals of High Specialty, the work plan of the service in which the palliative care whose name is established as Advanced Cardiopathy Patient and your Family Comprehensive Care Unit will be awarded. In the present study deals with how it is organized and the interventions of thanatology implemented.

The art of therapeutic letters in caring for grieving families / A arte das cartas terapeuticas no cuidado de familias enlutadas

The purpose of this article is to introduce the reader to the use of narrative and therapeutic letters as strategies in a holistic approach to Tanatology. This paper is based on free lecture thesis and presents congruence with fundamental patterns of knowing and key elements of the therapeutic letters. It offers a selected piece of qualitative research extracted from the context of a larger research study described the therapeutic letters as an instrument for summarized the interview. The article incorporated the textual description of two therapeutic letters that had been sent to a family that the child died. Emphasis is on the possibilities and influences of narratives and therapeutic letters on nursing practice with family bereavement. The paper is presented as an inspiration and evocation to write therapeutic letters.

O objetivo deste artigo e introduzir ao leitor o uso das narrativas de doenca para a confeccao de cartas terapeuticas, particularmente o seu uso como estrategia para o cuidado de familias enlutadas. O trabalho e baseado em tese de livre-docencia e apresenta a relacao entre os padroes de conhecimento que compoem o cuidado e os pontos chaves para a elaboracao de cartas terapeuticas. Relatamos a experiencia na elaboracao e envio dessas cartas as familias enlutadas que concordaram em participar de uma pesquisa qualitativa, cujo objetivo foi compreender o processo de decisao familiar sobre a doacao de orgaos do filho. Apresentamos duas cartas para ilustrar como as narrativas podem ser utilizadas na delineacao e construcao das cartas possibilitando seu uso na pratica de enfermagem e especialmente no cuidado de familias enlutadas. O artigo e apresentado como uma inspiracao e evocacao para o uso de cartas terapeuticas.

[Survival is not enough: taking care of the patient as a whole]. / Sopravvivere non basta--prendersi cura del malato nella sua totalità.

The ill deserve holistic care including assistance for the anxiety and fear generated by his illness. Illness may be viewed as a call for help, as the nocturnal side of life, or as a product of culture. All moments of the illness are precious, and its last instants may even reveal the infinite. The Western world is afraid of death--even now that our lives get longer--and abates the fear by removing the idea of death, even if poets have emphasized the richness it carries within.