Death studies
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Comparative Study
International comparison of studies using the perinatal grief scale: a decade of research on pregnancy loss.
The Perinatal Grief Scale (PGS) has been used in many studies of loss in pregnancy, including miscarriage, stillbirth, induced abortion, neonatal death, and relinquishment for adoption. This article describes 22 studies from 4 countries that used the PGS with a total of 2485 participants. Studies that report Cronbach's alpha for their own samples give evidence of very high internal consistency reliability. ⋯ The standard errors of the means for the total scale and for the subscales reveal fairly consistent scores, in spite of very different samples and types of loss; computation of means and standard deviations for the studies as a whole permits us to establish normal score ranges. Significantly higher scores were found in studies that recruited participants from support groups and self-selected populations rather than from medical sources, and from U. S. studies compared with those in Europe.
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This article serves as an Introduction to this two-issue special series of Death Studies on the integration of research and practice in thanatology. After discussing the lack of dialogue between researchers and practitioners in the field, the author identifies some common elements of the research and clinical processes in thanatology. ⋯ The author then offers suggestions for enhancing the exchange between researchers and clinicians, including improvements in theory, methodology, and the dissemination of research findings. Lastly, the individual articles in the series are introduced to the reader.
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Although the legal basis to refuse life supports is firmly embedded in the laws of all 50 states, there is evidence that a gap exists between patients' preferences and physicians' actions. Patients and their families have increasingly begun to turn to the courts for redress, requesting damages when a physician has ignored their request to forgo life-sustaining treatment. This article explores the reasons why patients' end-of-life medical choices are often ignored by the medical profession and the results of recent attempts to remedy these situations through the courts. Implications for practice are discussed, including practical suggestions for increasing the likelihood that a patient's wishes will be respected by medical providers.
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This study examines the process and consequences of an increasingly important element of the dying experience in American hospitals: the writing of a Do-Not-Resuscitate (DNR) order. The focus of the study is on the decision-making process and timing of the DNR decision, the impact of the DNR order on the dying experience, and the consequences of the DNR order for length of hospital stay and accrued medical charges. Patients with a DNR order are compared to those who were unsuccessfully coded. ⋯ Those with a DNR were more likely to remain in a single unit in the hospital and less likely to die in an intensive care unit or while connected to a ventilator. Consistent with other studies, however, average length of hospital stay and average medical charges were actually higher for the DNR patients. Implications of these differences between DNR and unsuccessfully-coded patients are discussed.
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Families of acute care patients who die while receiving care face loss and grief in unfamiliar institutional environments. Informal bereavement assistance may occur in acute care settings, but formally organized service and planned follow-up work with bereaved family members is less common. A literature review revealed little discussion of acute care-related bereavement services. ⋯ Health care workers such as social workers, psychiatrists, chaplains, and nurses, who are familiar with the psychosocial needs of families and the structure and staffing of these settings, are well-positioned to organize assistance for those experiencing sudden loss. Developing a formal bereavement program in acute care settings involves description of the need, presenting the rationale for the service, identification of program elements, and determination of resource needs. Even in situations in which full services may not be possible, the provision of basic assessment and referral services will be beneficial to survivors while offering the institution several benefits.