Psy. D., Antioch University, 2008, Antioch Seattle: Clinical Psychology

More treatment options exist today for persons diagnosed with terminal cancerextending lives longer than expected though there is little known about the psychosocial needs or resources for these individuals. This study describes the experience of living past the expiration date and still living with Stage IV cancer. A transcendental phenomenological approach was used to elucidate vivid expressions of this experience in a sample population of five Caucasian women. The women survived beyond their prognoses of an earlier expiration are not close to imminent death and are still living with incurable breast cancer metastases. The aim of this phenomenological inquiry is to illuminate the themes and essences of this phenomenon in hopes of expanding comprehension of the challenges this growing population confronts. Data was collected through individual open-ended, unstructured in-depth interviews. At a second meeting each woman, having been asked to find or create an expressive representation of their experience, verbally described their creations in an unstructured dialogue. All interviews were audio recorded and transcribed verbatim. Through the methodological processes of bracketing, phenomenological reduction, imaginative variation, and synthesis, the themes and essences that surfaced revolved around the constancy of change and duality. Five core themes emerged from the data: awareness of mortality; interaction with medical systems and treatment; living on a roller coaster; feeling different from others; cancer invades and changes how you live. All of the themes are interrelated and together capture the complexity of the lived experience. Living with dying longer than expected is an experience that profoundly impacts every aspect of these women's lives. It catapults them into a new paradigm where they have to renegotiate life daily. Each woman's lived experience is both unique and shares collective threads. The essences that emerge from the combined strands are a conti (open full item for complete abstract)

Committee: Mary Wieneke Ph.D. (Committee Chair); Ned Farley Ph.D. (Committee Member); Judith Gordon Ph.D. (Committee Member) Subjects: Mental Health; Oncology; Psychology; Womens Studies

Doctor of Philosophy, University of Akron, 2011, History

This dissertation is about death and its relationship to religion in late seventeenth-century England. The primary argument is that while beliefs about death stemmed from the Reformation tradition, divergent religious reforms of Puritanism and Arminianism did not lead to differing approaches to death. People adapted religious ideas on general terms of Protestant Christianity and not specifically aligned with varying reform movements. This study links apologetics and sermons concerning spiritual death, physical death, and remedies for each to cultural practice through the lens of wills and graves to gauge religious influence. Readers are reminded of the origins of reformed thought, which is what seventeenth-century English theologians built their ideas upon. Religious debates of the day centered on the Puritan and Arminian divide, which contained significantly different ideas of soteriology, a key aspect of a good death in the English ars moriendi. Puritans and Arminians regarded each other as political and religious enemies, yet their theology and teachings reveal the same understanding to the end of life and afterlife. Interestingly, people approached death identifying their common faith as Christians, not divided into different religious groups. Individuals heeded preachers' advice to recognize mortality and prepare for death in advance of the deathbed. Guidance from theologians emphasized hope and expectation of a blessed death through reliance on God and His promises. This dissertation contributes to narrowing a gap in the scholarship on late seventeenth-century English history and is also a work in thanatology that assesses how humanity has dealt with death. This research especially considers wills as a primary source to evaluate how society faced mortality and Christian teachings shaped conventional thought. The evidence also reveals an increasing value placed on family. Finally, this dissertation is a reminder that assessing the personal topic of death and d (open full item for complete abstract)

Committee: Michael Graham Dr. (Advisor); Michael Levin Dr. (Committee Member); Constance Bouchard Dr. (Committee Member); Howard Ducharme Dr. (Committee Member); Matthew Crawford Dr. (Committee Member) Subjects: European History; History; Religious History; Theology

Doctor of Philosophy, Miami University, 2024, Gerontology

Quality end-of-life care necessitates that patient preferences be known and honored by family and health care providers, as well as that care is both accessible and affordable. However, patient preferences are not always assessed, nor is the quality and cost of end-of-life care consistent throughout the United States. For individuals with multiple marginalized identities, achieving high quality end-of-life care is even more challenging, as compounding issues like systemic discrimination on the basis of race/ethnicity and gender are prevalent. The intersectional impact of race/ethnicity and gender on end-of-life care quality is largely understudied. To address this gap, I studied a sample of White, Black, and Hispanic US decedents (N=1,410; representing a weighted sample of nearly six million US adults) with data from the Health and Retirement Study core survey, leave behind questionnaire, and exit survey. Using binary logistic regression analyses, I explored how goal-concordance and satisfaction with end-of-life care are impacted by end-of-life care circumstances and aspects of power and privilege. Race/ethnicity and gender were used as moderating variables. Significant end-of-life care circumstances (i.e., discussing end-of-life care options, receiving home care, and longer length of hospice enrollment) reveal the importance of further integrating person-centered care practices into end-of-life care, educating patients on end-of-life care options, and addressing barriers to hospice enrollment for racial/ethnic minority populations. Several aspects of power and privilege were associated with greater quality of care, including not being eligible for Medicaid and absence of depression, which highlight policy and practice areas in need of reform. Further, race/ethnicity and gender were found to moderate the relationships between adverse childhood experiences and goal-concordant care, and perceived discrimination and satisfaction. These findings may help older adults, c (open full item for complete abstract)

Committee: Jonathon Vivoda (Committee Chair) Subjects: African Americans; Aging; Gerontology; Health Care; Hispanic Americans; Womens Studies

Doctor of Philosophy (Ph.D.), University of Dayton, 2021, Educational Leadership

The capabilities of modern medicine have precluded the sanctity of what it means to die, extending life while too often prolonging suffering along a trajectory of functional decline that typifies terminal illness, leaving patients with little say in how they want to experience their final days (Connors et al., 1995). End-of-life care has evolved to ensure that people with terminal illnesses know what to expect, understand their options, and have a voice in their care. It is the nurse-patient relationship at the bedside where patients express their wishes and the opportunity to advocate for patient-directed end-of-life care occurs. Unfortunately, these nurses often are not prepared for this role, cognitively or attitudinally. With an aging generation of baby boomers and prevalence of chronic illness, the need for nurses to be comfortable with end-of-life caregiving is urgent. This requires nurses to be educated in the principles of end-of-life care and possess attitudes conducive to putting their knowledge into practice. Often, though, nurses are confronted with their own attitudinal barriers toward death and dying borne of experiences in life that must first be overcome to freely empower their patients' voices and choices for care. Using a correlational design, the intent of this study was to learn how to improve nursing education in end-of-life care by determining the relationship between undergraduate student nurses' personal, didactic, clinical, and introspection life experiences with death and dying and their attitudes toward providing care to the dying. The study found that the personal, clinical, and introspective domains were associated with attitudes toward care of the dying with introspection showing the strongest correlation with attitudes. Forward regression, however, revealed that all four domains were predictive of attitudes toward care of the dying. Didactic experiences indirectly predicted attitudes by en (open full item for complete abstract)

Committee: Charles Russo J.D., Ed.D (Advisor) Subjects: Nursing

Doctor of Philosophy, The Ohio State University, 2021, Sociology

Dying is one of the few universal social experiences humans face and despite this ubiquity we lack deep understanding of how the contours of dying are navigated by all actors in the process. While the major task of sociological research, health social movements, and the actions of medical professionals has focused on improving the options available to and experiences of dying persons (a decidedly worthy cause), there has been considerably less focus on how the experience unfolds for familial caregivers of the dying. This dissertation explores how familial caregivers of persons in hospice navigate care, specifically interrogating how agency over the care context is not and is exercised. Data come from twenty-five semi-structured in-depth interviews with familial caregivers of persons enrolled in hospice within the past three years. Interviewees were asked questions within the broad categories of caregiving activities, interactions with family members while caregiving, interactions with medical professionals, and their general understanding of death and dying more broadly. From this effort I first sketch out three distinct caregiver archetypes respondents used to guide their approach to care. These archetypes included the unbiased ally, the deferential supporter, and the unbewitting bystander—all of which conveyed some degree of compliance with outside influences (typically the wishes of the dying person) that guided how care is to be ideally navigated. Secondly, I begin to explore how respondents exerted influence over the care context, albeit in limited ways, through subtle care correction. Subtle care corrections occurred in response to a care impropriety committed by another caregiving actor and subtle corrections were launched toward medical professionals and family members. Respondents described the subtle nature of their corrective efforts as the result of considering or protecting specific family members or general family dynamics in some way. These results (open full item for complete abstract)

Committee: Rin Reczek (Advisor); Kristi Williams (Committee Member); Eric Schoon (Committee Member) Subjects: Health; Sociology

Master of Arts, The Ohio State University, 2020, Bioethics

Moral distress is often framed as arising from interpersonal conflict such as moral disagreement. Within the dynamics of disagreement, moral distress becomes linked to power differentials present between the conflicting parties. As such, the understanding of the concept has commonly become dependent on constraints inherent to the nurse's professional role. Within this metanarrative of professional powerlessness, the proposed mitigation strategies have been narrowly focused. Given the widespread nature of moral distress they have also been largely ineffective. While moral distress in nursing remains pervasive, the majority of Americans are not dying well. The institutionalized deathbed in modernity is unlike any that have come before it. This paper traces death's trajectory of change exposing how technology and medicalization have come to authorize and direct the dying process. Spiritual needs of the dying have become obscured if not altogether denied. This has led to new rituals developing at the bedside of the dying. In the critical care environment, the ritualization of futility has become a culturally and institutionally mediated phenomenon. Americans not dying well and moral distress development in nurses may stem from the same healthcare system failures. In this scenario, effective mitigation will require large scale change. The profession of nursing is poised to be an integral partner in the collaboration necessary to affect just such a transformative change.

Committee: Matthew Vest Dr. (Advisor); Courtney Thiele (Committee Member) Subjects: Ethics; Medical Ethics; Nursing; Philosophy

Master of Arts, The Ohio State University, 2016, Comparative Studies

The constructs of health and person-hood are created by a culture's prevailing healing modality. This further defines how individuals experience dying. Through literature review and a personal narrative of American death, this thesis examines the unique situation of American medical authority as it is tied to the State through science-based validation and Cartesian duality. It is concluded that dying is not a dualistic process and therefore creates a dissonance that must be addressed for individuals to meet death well. Modifications can be made without a loss of cultural identity and there is evidence to support a model of Western medicine that embraces the reductionism needed to advance scientific research while encouraging a return to relational modalities at a General Practitioner level. A medical system that provides for more holistic care approaches, including a return to the original intent of Hospice, will be necessary to provide a less dissonant dying experience.

Committee: Katherine Borland (Committee Chair); Melissa Curley (Committee Member); Katherine Hendy (Committee Member) Subjects: Comparative

Doctor of Philosophy, University of Toledo, 2015, Health Education

Purpose: The purpose of this study was to determine if the Integrated Behavioral Model (IBM) was useful in explaining and predicting American adults' behavioral intentions to complete end-of-life care planning. Of specific interest was whether the IBM could help to explain racial/ethnic differences in end-of-life care planning. Methods: The study featured a theory-based, non-experimental, cross-sectional, survey research design. Participants were American adults between the ages of 40 and 80 years old. A geographically proportional sample based on the US census regions was randomly selected. An a priori sample size estimate indicated that a minimum of 384 completed surveys was needed to generalize the results to the US population of adults ages 40-80. Oversampling of racial/ethnic minorities was done to ensure that Blacks and Hispanics were adequately represented in the sample. To compensate for non-responses, a total of 1,650 American adults were included in the final sample. The IBM and the Precaution Adoption Process Model (PAPM) were used to design a valid and reliable survey. Prior to data collection, an elicitation phase featuring interviews and focus groups was conducted to ensure that the survey items were based on attitudes, beliefs, and perceptions that were highly salient to the priority population. After the survey was designed, it was pilot tested to ensure that the survey was readable, culturally acceptable, valid, and reliable. Data were collected via a four-wave postal mailing method that used best practices in survey research to ensure the optimum return rate. Results: A total of 386 surveys were completed and returned (25% response rate). The respondents were non-Hispanic White (65%), married (61%), male (52%), with a post-secondary degree (59%), and with a total household income of $70,000 and above (32%). The majority of participants (75%) had not completed end-of-life care planning. Approximately 1 in 3 respondents (36%) had completed a (open full item for complete abstract)

Committee: Timothy Jordan (Committee Chair); Joseph Dake (Committee Member); Jiunn-Jye Sheu (Committee Member); Barbara Kopp Miller (Committee Member) Subjects: Health; Health Education; Public Health Education

Ph.D., Antioch University, 2014, Leadership and Change

In Making Space for Dying: Portraits of Living with Dying, I describe the everyday lived experience of dying and the care culture within freestanding, community-based, end-of-life residences (CBEOLR) utilizing portraiture and arts-based research. I craft four case studies into "portraits," based on interviews, on-site visits, up-close observation, and field notes. In the person-centered portraits, I reveal the inner landscape of two terminally ill women, with data represented in poetry. In the place-centered portraits, I "map" the social topography of two CBEOLRs to illustrate how lives and care of the dying are emplaced, from the perspectives of community leaders, residence staff, volunteers, family members, and residents, with data presented as aesthetic (storied) narrative. Collage and photographs further enhance the text. Little has been written about the meaning of home and the centrality of a home-like environment in the healthcare milieu, specifically in the context of the end-of-life care setting. My research helps to fill a gap in understanding care culture in the freestanding CBEOLR, a care-setting genre rarely examined in the literature. Additionally, my study develops the notion of a "good place to die" and introduces the Home for the Dying, a CBEOLR model unique to New York State. Lastly, building on the literature on liminality, and informed by clinical practice as an oncology social worker, my study specifically highlights the terminal stage of cancer and introduces the concept terminal liminality, characterized by descent. Two broad dimensions emerged: Nesting-in-Being and Nesting-in-Place. Together, these dimensions created a framework for exploring care culture and ways of working with existential suffering. The bird's nest, as a utilitarian though temporal structure, provided an elegant metaphor for the special end-of-life residence. Three linked sub-themes related to care culture emerged, Nest of Simple Things (meaning making), Nest of Belonging (open full item for complete abstract)

Committee: Carolyn Kenny PhD (Committee Chair); Alan E. Guskin PhD (Committee Member); Carol S. Weisse PhD (Committee Member); Timothy E. Quill MD (Other) Subjects: Aging; Behavioral Sciences; Families and Family Life; Gerontology; Health Care; Individual and Family Studies; Medicine; Oncology; Public Health; Social Psychology; Social Work

Master of Education (MEd), Bowling Green State University, 2014, Reading

Death and dying is a very sensitive subject and must be treated as such. Since literature may be first time adolescents may encounter death, it is important to understand what adolescents are learning from reading certain literature. Depending on how books portray death, some literature may be considered more valid than others. Some literature may be portraying death as accurately as possible, while other books may teach or convey the wrong message. Kubler-Ross is a renowned researcher famous for the Five Stages of Grief that include denial, anger, bargaining, depression, and acceptance. The purpose of this study was to see if adolescent literature aligned with the Five Stages of Grief by Kubler-Ross. Seven adolescent literature books were selected an analyzed. The books had to a work of fiction, written towards adolescents, and published after 2000. The books were read and examples of each stage of grief were recorded on a data chart. After reading, conclusions and recommendations were made. After analyzing the results, it was concluded that all books included the stages of anger and acceptance. Anger was generally represented by yelling, breaking objects, or using curse words. Acceptance was generally found towards the end of the book, after the characters had found what they were searching for. Bargaining was the stage that was least likely represented in the literature. It is recommended that teachers, counselors, or parents read the same literature as adolescents to know what they are learning from literature about death and dying. If these books are being used as bibliotherapy, if each stage is not represented, it is recommended that the stages that are not represented are supplemented with additional material or conversation.

Committee: Cindy Hendricks (Advisor); Trinka Messenheimer (Committee Member); Penny Soboleski (Committee Member) Subjects: Education; Literature

MA, Kent State University, 2013, College of Arts and Sciences / Department of Philosophy

The Doctrine of Doing and Allowing (DDA) is the ethical principle that doing harm is morally worse than allowing harm. The objective of this thesis is to show that the DDA is not a viable principle without supplementation. Deontological and consequentialist approaches to the DDA are explored in this thesis. Both approaches are rejected due to the limitations of the binary approach to harms---the binary approach to harms is the assumption that the badness of harms is best captured by two strict categories of doing and allowing. This thesis develops a sliding-scale approach to harms. This approach is developed by using axiology---value theory. Value theory is used by consequentialism to determine what goods should be maximized by action and how those goods are ranked. This thesis uses the axiological methodology of Fred Feldman to create a more complex account of the badness of harms. The final chapter of this thesis applies the sliding-scale approach to harms to three end-of-life, medical cases.

Committee: Deborah Barnbaum Ph. D. (Advisor); Linda Williams Ph. D. (Committee Member); Kimberly Garchar Ph. D. (Committee Member); Manacy Pai Ph. D. (Committee Member) Subjects: Ethics; Medical Ethics; Philosophy

Master of Fine Arts, The Ohio State University, 2011, Art

Making With Caution, my most recent art installation, will serve as an investigation into the meaning of death and dying. It will be on display at the Urban Art Space, in Columbus, Ohio, and will operate as a culmination of my formal education in contemporary fine art. Furthermore, it will operate as evidence of my very existence, and will abstractly illustrate the quiescence of death and dying through a video, perceived live performance, and sculpture. Each of these three components will be deconstructed in great detail in regards to their conversation in fine art and religion. In the following pages, I will examine how art may appease the overwhelming angst associated with death and dying, which consequently allows me to enjoy, savor, and appreciate the little time I have on earth. Through a thorough investigation of Making With Caution, I will describe how I use art as a supplement to pacify my anxiety related to my fear of death, and how it operates as a direct consequence of my current spiritual dissatisfactions.

Committee: Robert Derr Mr. (Advisor); Tony Mendoza Mr. (Committee Member); Alison Crocetta Ms. (Committee Member) Subjects: Fine Arts

Doctor of Philosophy in Urban Education, Cleveland State University, 2009, College of Education and Human Services

Student nurses are involved in caring for patients who are actively dying or who have been told they have a terminal illness and are faced with the process of dying. Students encounter these patients in hospitals, nursing homes, at home or in hospice care settings. According to Robinson (2004), “nurses are the healthcare providers that are most often with individuals at the end of their lives” (p. 89). Nurses should be knowledgeable about end-of-life care. Studies show that only 0.41% of nurses are certified in palliative care (Means to a better end, 2004). Nursing students often have a difficult time coping with the stress that comes with caring for those who are dying (Johannsson and Lalley, 1990-91). Student nurses need to be prepared to take an active role in caring for patients who are dying or have been told they have a terminal illness. Students are in clinical settings where they may encounter death and dying. These settings include hospitals, nursing homes, and community/home care areas. Understanding students' perceptions of death and dying can help educators prepare students for these situations by using the research available to plan better ways to teach students about the needs of the dying/terminal patient and their family. These needs include physical, spiritual, emotional and social. A qualitative investigation with thirteen junior level nursing students from a large urban university in Northeast Ohio was used in the research. Findings revealed that an emphasis on the domains of thoughts, feelings, communication, multicultural diversity, education and coping mechanisms are essential in nursing education. Participants reported a need for additional education in the area of communication and culturally responsive care. This study suggests that there is a great need to educate students about death and dying, cultural competence, communication skills and coping with emotional stress.

Committee: Rosemary Sutton PhD (Committee Chair); Donna Schultheiss PhD (Committee Member); Cheryl Delgado PhD (Committee Member); Vida Lock PhD (Committee Member); Lonnie Helton PhD (Committee Member) Subjects: Communication; Education; Nursing

Doctor of Philosophy, Case Western Reserve University, 2010, Nursing

Little evidence exists regarding best practices for pediatric end-of-life care in Thailand. Most studies from Western cultures focus on adult patients; available studies in pediatrics focus on care delivered outside the intensive care unit (ICU). Nearly all pediatric deaths in Thailand occur in ICUs. This study aimed to explore nurses' perceptions of the quality of dying and death, barriers and facilitators to providing pediatric end-of-life care in Thai ICUs and examine relationships among these variables. The study framework was based on Donabedian's structure, process and outcome model. A descriptive correlational design was used on a convenience sample of 129 neonatal and pediatric ICU nurses from two university hospitals in Thailand. Data were collected using self-administered anonymous versions of the Modified Quality of Dying and Death and the Modified National Survey of Critical Care Nurses regarding End-of-Life Care surveys. Open-ended questions were used to elicit data on additional barriers and facilitators not addressed by the standardized instruments and to obtain suggestions to improve pediatric end-of-life care. The results revealed that critical care nurses perceived a moderate quality of dying and death for infants and children in Thai ICUs (Mean = 52.89, SD = 15.43). The overall model demonstrated all three barrier and facilitator predictors (patient-family-related, healthcare-professional-related, and organizational-related) significantly affected the quality of dying and death (p < .001) with 33-34% of the variance explained. Barriers and facilitators related to healthcare professionals significantly contributed to quality of dying and death. The highest ranked of these healthcare-professional-related barriers were having disagreement among physicians about direction of care, time constraints, and insufficient knowledge of end-of-life care. The three highest ranked healthcare-professional-related facilitators were agreement of physicians about di (open full item for complete abstract)

Committee: Elizabeth Damato (Committee Chair); Barbara Daly (Committee Member); Maryjo Prince-Paul (Committee Member); Christopher Burant (Committee Member); Elizabeth O&#8217; Toole (Committee Member) Subjects: Health Care

Master of Education (MEd), Bowling Green State University, 2007, Reading

Death and dying are experiences that all children will face or are currently facing. Children bring the results of those experiences with them into the classroom. Teachers are then placed in a situation in which they must handle this issue. Therefore, a way to help these bereaved children in the classroom is needed for the best possible learning to occur. One way that teachers can help is through a process similar to that of bibliotherapy. Bibliotherapy is an approach that uses children's literature to help children come to positive resolutions by engaging in the same issues in which the characters in the book take part. The purpose of this study was to analyze 35 children's picture books published between 2000 and 2006 to determine how death and dying were portrayed. After carefully reading and analyzing each book, a matrix of 10 characteristics was developed. Data were then gathered through a content analysis of each book. From this content analysis the main categories were determined within each characteristic. From this study, it was concluded that the 35 books would be appropriate to use in a primary grade classroom. These books could be used by K-3 teachers in a bibliotherapy-like approach to help bereaved children in their classroom, or as tools to help children better understand death and dying. As a result of this study, a matrix of characteristics and book summaries were developed from the 35 books used. The matrix of characteristics and the book summaries can be used as resources for teachers, parents, school personnel, children's book authors and educational researchers who would like more information about the characteristics of children's picture books about death and dying to use these books with children or for further research.

Committee: Tim Murnen (Advisor) Subjects:

Master of Arts, Miami University, 2013, Psychology

Although researchers have investigated death attitudes since the 1960s, only a few have examined death acceptance as a research topic. Furthermore, most of these studies focused on quantitative assessments without finding consistent results. In this study, I conducted a qualitative investigation on the role of intimate relationships in accepting death. I interviewed four older adult participants about their death attitudes and intimate relationships in semi-structured interviews. From the results, I found that the male participants needed to deepen their relationships before accepting death, whereas the female participants already had intimate relationships and were able to accept death immediately as they became aware of their mortality.

Committee: Larry Leitner Ph.D. (Advisor) Subjects: Clinical Psychology; Psychology