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PERCEPTIONS OF NURSING FACULTY
TOWARD
NEAR-DEATH
EXPERIENCES AND DEATH BED VISIONS
by
Linda H. Moore
A Dissertation Submitted in Partial Fulfillment of
the Requirements
for the
Degree of
Doctor
of Education
Division of
Educational
Administration
Leadership and Higher Education Program
in the Graduate School
Texas A & M University-Corpus Christi
December 2010
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UMI Number:
3484576
All rights
reserved
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3484576
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ABSTRACT
Perceptions of
Nursing
Faculty
Toward
Near-Death Experiences and Death Bed Visions
Linda H. Moore, Ed.D., Educational Leadership,
Texas A
& M
University-Corpus Christi, 2010
B.S.N., University of Texas Health Science Center,
San
Antonio, 1987
M.S.N.,
Radford University,
1990
Dissertation directed
by Dr.
Raul Prezas and Dr. James Walter
Nursing faculty perceptions toward near-death
experiences
and
death bed visions
were
explored using an electronic survey
that
encompassed quantitative
and
qualitative
methods.
A total of 3,673 surveys were sent out across the United States, including the
territory of Guam, and 571
nursing
faculty
participated
in the study.
The
average
participant was a
60-year-old female
who had either
a master's
degree
or a doctorate.
Additionally,
half of the
participants
had
worked with near-death
experience patients and
indicated
that they had
a
near-death experience. In
regard to nursing education and
leadership, nursing faculty strongly believed
that
students should be allowed to care for
patients who have experienced near-death events as well as to
conduct research in the
area. Qualitative findings revealed similar
themes
in patients who experienced death bed
visions and those
who
had near-death experiences. Numerous anecdotal accounts were
described by the nursing
faculty who participated in
the
study.
Recommendations
included incorporating content about near-death
experiences
and
death
bed visions
into
nursing curriculum and providing in-services
to
nurses through professional nursing
organizations that focus on near-death phenomenon events.
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PERCEPTIONS OF NURSING FACULTY TOWARD
NEAR-DEATH EXPERIENCES AND
DEATH
BED
VISIONS
A Dissertation
B y
LINDA
H. MOORE
This dissertation meets the standards for scope and quality
of
Texas A & M University- -Corpus Christi and is hereby approved.
d.D.. Co-chair
aurR.
P
Pate, Ph.D.,
Cojfamit tee Member
K. Walter,
Ed.D.,
Co-chair
Bryant Griffith, Ph.D.,
Graduate Faculty Representative
Luis Cifuentes, Ph.D.
Associate Vice President
for
Research and Scholarly Activity and
Dean
of
GraduateStudies
December,
2010
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DEDICATION
The
dissertation
is dedicated to Mr.
Leonard Leos,
MSN, RN, St. Philip's ADN
Program Director who
wanted
so
much to make
his
Dean proud of him
by
completing
his
doctorate
in Public Health,
but
whose
life was cut
short prematurely
on September 14,
2010, at the age
of
51.
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ACKNOWLEDGMENTS
The
writer
wishes to
acknowledge the
following individuals
who have done so
much to contribute to
the
success of the experience:
First,
I
would
like to thank Dr. Raul Prezas and
Dr. James
Walter,
who
never
doubted the abilities of
the
researcher to complete
the
research study.
I would like
to
thank Dr. Bryant Griffith, dissertation
committee
member and
professor who reminded students, "If you can persist, you can achieve."
I would like to
thank
Dr. Christopher Pate, Dean of Health Sciences St.
Philip's
College.
The
road
at
St.
Philip's
College has been rocky from the beginning to the end.
The researcher hopes to have obtained your respect for accomplishments achieved to
include the completion of my dissertation. Like Leonard,
I,
too, want you
to be
proud of
me.
I would
like
to thank
my
mother, Gwyn Hutton, and
my
deceased
father,
Dr.
Kenneth E. Hutton, for encouraging me in all life endeavors to strive toward excellence.
I would like to thank my two sons, Eric and Ryan. Your success in life
will
fulfill
the hopes
and dreams of
your father
and me. We love you
both
more than
you can
imagine.
Last,
but
never least, my husband, Terry, who has been at my side
along the
long
and difficult educational journey. Terry deserves to be hooded more than I
do.
All I can
say
is
that
I
love him
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TABLE OF
CONTENTS
DEDICATION iv
ACKNOWLEDGMENTS v
LIST OF TABLES ix
LIST OF
FIGURES
x
CHAPTER 1: INTRODUCTION 1
Background
of
the
Problem 1
Statement of
the
Problem 4
Theoretical Framework 5
Purpose
of the
Study 8
Research Questions
9
Significance of
the Study 9
Definition
of Terms
10
Glossary 10
Limitations of the Study 16
Assumptions of
the
Study 16
Organization
of
the Study 16
CHAPTER
2: LITERATURE REVIEW
17
Components
of
Near-Death Experiences and Death Bed Visions 17
Life-Span Perspectives of Near-Death Experiences 20
Pediatric Population 20
Adult
Population
21
Elderly Population
22
Personal
Anecdotes
of Death Bed
Visions 23
Attitudes toward Near-Death Experiences
23
Clergy's
Attitudes toward Near-Death Experiences 24
Hospital Nurses' Attitudes toward Near-Death Experiences 24
Hospice Nurses' Knowledge of and Attitudes toward Near-Death
Experiences 25
Physicians'
Knowledge of and Attitudes toward Near-Death
Experiences
25
Psychologists' Attitudes toward Near-Death Experiences 26
Attitudes toward Death Bed Visions 26
Scientific Basis for
Near-Death
Experiences
and
Death Bed Visions 27
Ketamine 27
Ibogaine 27
Dimethyltryptamine
28
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Anoxic States 28
Cardiac
Arrests 28
Quantum Biomechanics 29
Philosophical and Theological
Meanings of Near-Death Experiences and
Death Bed Visions 29
Summary 33
CHAPTER 3: METHODOLOGY 34
Purpose
and
Research
Questions
34
Research Design 34
Participant Selection
35
Instrumentation 36
Data Collection 37
Data
Analysis 38
Summary 38
CHAPTER 4: RESULTS 39
Quantitative Findings 39
Participant
Demographics 39
Knowledge of Nursing Faculty of Near-Death Experiences 43
Attitudes of Nursing Faculty toward Near-Death Experiences
44
Attitudes of Nursing Faculty toward Near-Death Experience Patients 44
Qualitative Findings
45
Near-Death Experience Themes 46
Death Bed Vision Themes 49
Summary
49
CHAPTER 5: DISCUSSION, CONCLUSION,
AND
RECOMMENDATIONS
51
Introduction 51
Summary of
Results
and Discussion 51
Conclusion 55
Recommendations
for
Practice 57
Recommendations
for
Future Research
58
REFERENCES 59
APPENDIX A: NEAR-DEATH EXPERIENCE ACCOUNT OF A VIRGINIA
STATE TROOPER 69
APPENDIX
B:
DEATH BED VISION ACCOUNT OF A HOSPITAL
PATIENT 70
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APPENDIX
C:
FAMILY MEMBER'S ACCOUNT OF HER MOTHER'S
DEATH BED VISION 71
APPENDIX D:
DRUG-INDUCED NEAR-DEATH
EXPERIENCE
ACCOUNT
73
APPENDIX
E:
IRB FORM 75
APPENDIX F: NEAR-DEATH PHENOMENA KNOWLEDGE AND
ATTITUDES QUESTIONNAIRE 78
APPENDIX G: SAMPLE COVER LETTER WITH CONSENT
INFORMATION 92
APPENDIX H:
REPORTS OF NEAR-DEATH EXPERIENCES AND DEATH
BED VISIONS TABLE 93
APPENDIX I:
RESULTS OF PARTICIPANTS' SCORES ON KNOWLEDGE
OF NEAR-DEATH EXPERIENCES
94
APPENDIX J:
RESULTS OF PARTICIPANTS'
GENERAL
ATTITUDES
TOWARD NEAR-DEATH EXPERIENCES 99
APPENDIX
K: RESULTS OF PARTICIPANTS' ATTITUDES TOWARD
CARING FOR
AN
NDE PATIENT 103
APPENDIX L: SAMPLE OF PARTICIPANTS' UNALTERED REPORTS OF
NEAR-DEATH EXPERIENCES 107
APPENDIX
M:
SAMPLE
OF PARTICIPANTS'
UNALTERED REPORTS OF
NEGATIVE "HELLISH" NEAR-DEATH EXPERIENCES
AND DEATH BED VISIONS 110
APPENDIX N: SAMPLE OF PARTICIPANTS' UNALTERED REPORTS OF
DEATH BED VISIONS Ill
APPENDIX O:
SAMPLE OF PARTICIPANTS' UNALTERED REPORTS OF
AFTER-DEATH VISITATIONS 112
BIOGRAPHICAL DATA: LINDA
MOORE 113
Vlll
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LIST
OF
TABLES
1. Participant
Consent
39
2. Participant
Ethnicity 40
3. Participant Educational
Level
41
4.
Participant Religious/Spiritual Background 42
I X
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LIST OF FIGURES
1. Theoretical framework
8
2. Triangulation-convergence design model
35
3. Near-death experience and
death bed
vision themes 46
x
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1
CHAPTER 1
INTRODUCTION
The "near-death experience" is
a
topic evoking strong feelings either positively or
negatively. Physicians
and
nursing practitioners
and textbook
publishers
often dismiss
the
"death
bed"
phenomena as a
hallucination or drug induced. The medical community
finds it acceptable
and
preferable
to
keep the concept away from pre-service nursing
students.
The cursory dismissal
is not the best way
to educate nursing students to deal
with patients or
families of
patients when the
phenomena occur.
Effective
leaders
have the capacity to create and motivate and to never be
satisfied with the status quo. Effective leaders
create
new paths and effective leaders are
not
constrained by
conventional
methods or standard operating procedures. Effective
leaders
work
to
create change
and to
bring about new understanding.
Effective leaders
are
willing
to take responsibility, complete duties and hold
a
mental toughness despite
criticism.
The chapter presents an introduction and overview of the dissertation. The
chapter begins
with
the background
of
the
problem, followed
by the
statement
of the
problem, theoretical framework, purpose of the study, research questions, significance of
the study, definition of terms, glossary, limitations, and assumptions. The chapter
concludes with the organization of the study.
Background of
the
Problem
A controversial topic,
especially
among healthcare providers, is
patients'
experience of
a
phenomenological-spiritually-based encounter (Greyson, 2008). The
near-death experience (NDE) has been reported by increasing numbers of patients
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2
receiving
care in and
out of
healthcare
facilities. According to
a
Gallup poll,
reported by
the
International Association of Near-Death
Studies
(2008),
over
13
million
Americans,
not including children, have reported having had
an
NDE as
a
result of a close encounter
with death. An NDE can
be
summarized as
a
close encounter with death, and many of
the experiences are described as
a
spiritual metamorphosis (Greyson,
1985;
Moody,
1975,
1988;
Ring, 1984). An NDE has 15 distinct
attributes,
one of which
is
indescribable knowledge (Greyson,
2005).
Flew (1955) addressed the concept of indescribable knowledge in philosophical
terms. Flew believed that events are interpreted within philosophical meanings and that
reasonable inductions are part
of
the behavioral patterns and beliefs engendered in the
human species.
There is
a
world of difference between saying that it is reasonable in certain
circumstances to act
inductively (which is
a
value matter, one of
commending
a
certain sort of behavior); and saying that most people regard
it
as reasonable so to
act (which is a factual matter
one
of neutrally giving information about that kind
of behavior). Thus that too short way with the problem of induction, which tries
to deduce that induction is reasonable from the premise that people regard it as so
or even from the fact that they
make
inductive behavior part of their paradigm of
reasonableness, will not do: it is necessary for each of us tacitly or explicitly
actually to make our own personal value commitments here. Most of us are in
fact willing to make that
one
which is involved in making inductive behavior part
of
our
paradigm
of
reasonableness
(pp. 35-36).
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3
Other components
of
an NDE include hearing about one's own demise, usually
vocalized by healthcare professionals; a feeling of peace and serenity engulfing the
experiencer;
unusual
noises, varying in description from distant bells ringing to a sound
similar
to a
buzz
saw;
an out-of-body experience (a hovering-type experience whereby
the individual
sees occurrences in present
time
as if viewing
a movie;
seeing
a
tunnel
with
incandescent
lights illuminating a path
toward spiritual
enlightenment;
seeing
beings
of light,
representing deceased relatives
and/or
higher spiritual creations; meeting a
Supreme
Being, identified
by
many as one of
the
Trinity;
conducting a
life review;
feeling that
one is
at
the
edge of no
return,
often
equated
to a cliff whereby the
individual
is offered a choice of whether
to
return to the
body
or move into death; returning
to
body,
with ambivalent feelings described as
a
sudden jolt of intense pain
at
the moment of
return; informing others of one's death, expressed
by
the experiencer with hesitation for
fear of being discounted; undergoing personal adjustments, resulting
in
changes in
lifestyle and beliefs; a change in attitude toward
dying, with decreased fear
of
death;
and
collaboration
of
the experience, engaging
in
thoughtful interaction with others having
experienced the phenomenon (Perry, 1988).
Family
members have
reported incidences in which
a dying
relative displayed
characteristics
of engaging
in
conversations with (invisible) images of deceased family
and
friends.
Death bed visions (DBVs)
are
frequently
witnessed
by families
sitting with
a
dying loved one, who reports such visions (Wills-Brandon, 2000). Accounts of the
appearance of ghostly apparitions
at
the time of death
have
been recorded
by
individuals
dating
from ancient
times (Brayne, Farnham, & Fenwick, 2006).
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4
NDEs
and
DBVs have an enormous impact on both
the patient
and family
members (Greyson, 1997). The direct care nurse charged with holistic care must be
knowledgeable and accepting of NDEs and
DBVs
to provide
culturally
competent care to
both the patient and
family members. The importance of ensuring
that the direct-care
nurse has received instruction, allowing for exploration of near-death phenomena, cannot
be underestimated (Brayne, Lovelace, & Fenwick, 2008).
The nursing educator
is the individual who provides initial
mentoring
of the
student nurse and prepares
the
student nurse for a lifelong career in
the
comprehensive
delivery of care to patients and families of patients (McGovern-Billings &
Flalstead,
1998).
The
licensed
nurse
is
generally
the
first licensed
healthcare professional
to
encounter a patient
having
an NDE or a DBV
(Texas
Board
of Nursing,
2009).
Statement of the Problem
Near-death phenomena
have been discussed by
some
professionals and have
received media coverage
through movies, talk shows, newspaper articles, books,
magazines, and research journals
(Parnia, 2008).
Discussions have taken place
among
experienced researchers and healthcare providers, including critical care nurses (Oakes,
1981), psychologists
(Walker
& Russell,
1989), hospice
nurses (Barnett,
1990) and
physicians (Moore, 1994).
Nursing textbooks do not contain information about NDEs or DBVs (D. Dobbs,
personal
communication, March 18, 2009).
The
lack of coverage in textbooks gives
the
message that NDEs and DBVs are not important enough to include in the comprehensive
education
of nursing students and
mitigates against
their
being
discussed
by
nursing
students.
As a
result, nursing students are currently
unprepared
to engage patients and
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5
families of patients encountering NDEs and
DBVs (R.
Spruill, personal communication,
February 10, 2009). Although there is recognition that exploration of NDEs and DBVs is
important to providing holistic, culturally competent nursing care,
no
research that
involves a comprehensive exploration of knowledge and attitudes toward NDEs or
DBVs
among nursing educators has been conducted.
Theoretical Framework
An
understanding of NDEs and DBVs is
part
of a multi disciplinary
phenomenological
model that
takes
into
account the psychosocial, spiritual, and
philosophical
aspects
of
NDEs
and
DBVs (Corcoran,
1988).
Research from
the
perspective indicates
that
the NDE is
an
authentic phenomenon that
is
essentially
the
same in whatever country or culture
it
occurs. The only difference seems to be that the
individual will see the religious idol pertaining to
his/her
religion. There seems to
be
no
correlation with religion, age, sex, educational background, financial status or psychiatric
history (Cole, 1993, p. 157).
The theoretical framework,
Watson's
(1988) Model of Human Caring, coupled
with
Flew's
(2007) concept of human perceptions,
provided the
foundation for
the
research.
Watson's Model
of
Human
Caring, more
specifically, the
Actual
Caring
Occasion (ACO), contains an acknowledgment of NDEs
and DBVs
(Watson, 1994),
which comprise the ACO. The ACO is
a
multidimensional phenomenological experience
that is
greater
than
the sum of its caring events, and
it
views individuals engaged in the
therapeutic
experience
as part
of
the
whole caring
phenomenon
(Watson, 1985).
The whole caring-healing-loving consciousness is contained within
a
single
caring
moment.
The one caring and the one
being
cared for are interconnected;
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6
the caring-healing process is connected with
the other
human(s) and
the
higher
energy of
the
universe;
the
caring-healing-loving consciousness of the nurse is
communicated
to
the one being cared
for; caring-healing-loving consciousness
exists
through and
transcends time
and
space
and
can
be
dominant over
physical
dimensions. Within this context,
it
is acknowledged that
the
process is relational
and connected; it transcends
time,
space and physicality. The process is
inter
subjective
with
transcendent possibilities
that go
beyond the given
caring
moment (Watson, 2010, pp. 116-117).
Watson and
Foster
(2003) emphasize
the
importance
of
maintaining
the
caring-
healing process as
a
continuous plan of patient care, stating:
The dynamics of relational, human-to-human caring practices and comprehensive
therapeutic
modalities
for
caring-healing seem to be eclipsed by
the
daily
routines, mechanics and demands of economic, management, physical and
technological aspects of care.
The heart of the necessary changes needed for
renewal and transformation seem to
be
dependent
on
human dimensions and skills
that result in transforming patterns and depths of communication, relationships
and healing modalities. These human caring-healing dimensions transcend
profession, system
and
institutional
structures (p.
361).
Individuals experiencing the
ACO
include the nursing faculty, of which
the
nursing
student is
a
part.
Flew's (2008) perspective allows for
the
experience of NDEs and DBVs. He
defined perceptions as sensory events that individuals experience
and
believes that
having faith is justified.
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7
It
remains to consider
the possibility
of there
being
evidence
which,
though
less
than decisively probative, might nevertheless
be
sufficient to justify bets of faith.
As my Father,
a
Methodist preacher often said in sermons: 'Faith is not
a
leap in
the dark but a
leap
towards the Light ' (Flew, 2010).
In
keeping with Flew's perspective, Taylor and Watson (1989) believe that
NDEs
and
DBVs
are
actual human sensory experiences exemplifying
the
phenomenal fields
created within
the
ACO.
Nursing faculty, who contribute to the caring-healing process through mentoring
students, need to have certain characteristics: (a) spiritually supportive of
the
nursing
student;
(b)
competent in nursing abilities; and (c) providing nonjudgmental therapeutic
communication. Additionally, nursing faculty must
be
knowledgeable about NDEs and
DBVs
and must
acknowledge
patient
sensory perceptions (Watson, 1999, 2005). That
nursing faculty should acknowledge and discuss NDEs and
DBVs
illustrates the
significance attached to patients' sensory experiences (Bevis & Watson, 1989).
Acceptance
of
the existence of NDEs
and DBVs allows the providing of holistic spiritual
care by
the
faculty member and the nursing student. Flew (1977) wrote about care as
related to
knowledge
and
emphasized the
importance of
an individual's belief system.
Care is also always required about knowledge and refutation. To say that
someone knows something
is
to
say
more than
he claims
to know it,
or
that
he
believes
it
most strongly.
It
is
to say also, both
that it is
true, and that
he is
in
a
position to know. So neither the sincerity of
his
conviction nor the ingenuousness
of
his
utterance guarantees that he knew. . . If you
do
not want
to
say as
much
as
that, then you should take the trouble to
be
non-committal. You ought to say
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8
only:
in the
one case, that he believed,
and claimed
to know.
. .
In
the all
too
common abusage I have my opinions and my convictions,
but
you and he merely
have
prejudicesso called for
no
better
reason
than that
they
are
yours or his and
not mine (pp. 28-29).
The combination of Watson's theory of caring and Flew's concept of human
perceptions
creates
a foundation for studying perceptions of
NDEs and
DBVs of
healthcare professionals. The theoretical framework is presented in Figure 1.
First Field
Past
History
The RN that
will become
the Nursing
Faculty
who
is providing
care
to
the
Patients /
Families
who
have
had NDEs
and DBVs.
ACO&
H u m a n
Perceptions
Second
Field
Present Flistory
The
Nursing Faculty
mentors the Nursing
Student and
engages
in holistic
&
open
dialogue that
supports those
attributes of Human
Caring toward the
goal
of learning &
understanding
NDEs and DBVs
by
way
of simulation.
ACO&
Human
Perceptions
Third
Field
Future History
The Graduate
Nurse
is
now equipped
with
the
holistic knowledge
and
attitudes which were
engendered by
the
Nursing
Faculty
to
care
for Patients /
Families
who
will report
having
had
NDEs
and
DBVs
& will now be able to
provide holistic &
culturally
competent
care
for
these clients
and their families.
ACO&
Human
Perceptions
Figure 1. Theoretical framework.
Purpose
of
the
Study
The primary purpose
of
the
study was to assess knowledge (beliefs), attitudes, and
views of nursing faculty toward
NDEs.
The secondary purpose was
to
explore
perceptions of nursing faculty toward
DBVs.
Nursing instructors
mentor nursing
students
who will be
responsible for
the
direct
care of patients and their families, including patients experiencing NDEs and DBVs. The
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9
nursing
instructor is
in a
position to introduce nursing students to the psychosocial
and
spiritual aspects of near-death phenomena, including NDEs and DBVs.
Nursing faculty can potentially have
a
positive impact on
the
nursing
student's
ability to engage patients and families who report near-death phenomena. If the nursing
instructor demonstrates a lack
of knowledge
or negative
attitudes toward
NDEs and
DBVs,
healthcare delivery would
not be
compassionate. Ascertaining
the
attitudes
of
nursing faculty has implications for
the
education of nursing students, particularly
because
discussion of
NDEs and
DBVs
is not
included in nursing textbooks.
Research Questions
1. What do nursing faculty know
about
near-death
experiences?
2. What are the attitudes of nursing faculty toward near-death experiences?
3. What are
the
perceptions of
nursing faculty
regarding near-death experiences?
4. What are
the
perceptions of nursing faculty regarding
death
bed visions?
Significance
of
the
Study
NDEs
and
DBVs are considered
to
have spiritual
implications
for patients
and
families having
had
these types of encounters. Thus,
it is essential
to ensure that first-line
licensed healthcare providers (i.e., nurses) have received adequate education about these
experiences.
Lack of knowledge of these phenomena by the nursing faculty would be
detrimental to student nurses and
the
delivery of competent
holistic
care once they are
licensed
as
professionals. The nursing faculty member plays
a
key role
in
the mentorship
of the nursing student by engaging in dialogue about near-death
phenomena,
enabling
graduate
nurses to provide
culturally
competent
care
to clients
and families
who
may
encounter NDEs
and DBVs
(Wells, 2000). The study allowed exploration of knowledge
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10
and attitudes toward NDEs as well as of
awareness
of patients having reported
DBVs.
The
study also identified the need
for information on
NDEs and DBVs in
nursing
textbooks.
Definition
of Terms
The following
terms
were operationalized for
use
in
the
study:
Altitude is
a
predisposition including behaviors, feelings, perceptions,
and
thoughts about certain phenomenon (Kerlinger, 1974). Attitude, for the purpose of the
study, was operationalized as the Likert-scaled responses
to the
attitude portion of
The
Near-Death Phenomena Knowledge and Attitudes Questionnaire
(Thomburg,
1988).
Knowledge is
the awareness
of being familiar or
aware
of something that is
gained through
life
experiences
("Knowledge" 2009).
Knowledge, for the purpose of
the
study, was operationalized
as
the Likert-scaled
responses to the
knowledge portion
of The
Near-Death
Phenomena Knowledge
and
Attitudes Questionnaire (Thornburg, 1988).
Perceptions are
statements
or
views
that
are identified through
individual
responses that
may be
anecdotal in nature (Patton, 1990).
NDE
and DBV perceptions
were measured and documented by analyzing and synthesizing the
focus
group
participants' qualitative data.
Glossary
Abdominal
pain
is an uncomfortable sensation in the stomach and/or epigastric
region of
the
body
(Smeltzer,
Bare, Hinkle,
&
Cheever,
2009).
Actual caring occasion (ACO)
is
a
transcendental, shared experience
between
nurse and patient,
facilitating
the
essence of caring,
healing, and
wholeness (Watson,
2010).
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11
Adenoidectomy is a surgical removal of the adenoids, a lymphoid tissue located in
the nasopharygeal region (Como, 2006).
Anoxic is the absence of oxygen to vital
organs
or
body
tissues resulting in
physiological
deterioration (Potter & Perry, 2007).
Arrest is a
cessation of
physiological
activities (Como,
2006).
Artificial
life
support is artificial means, typically of
a
mechanical nature,
necessary to keep an individual alive
(Linton, 2007).
Breast
cancer is
an abnormal condition involving malignant or benign cell growth
in
the
breast region of
the
body
(Ricci, 2009).
Cardiac
arrest
is
the
cessation of
the heart
beat
(Perry
&
Potter, 2007).
Cardiac
bypass
surgery is a surgical
procedure that involves
the
replacement
of
diseased heart vessels with synthetic or donor
site
vessels to facilitate blood
flow
to
the
heart (Smeltzer
et
al., 2009).
Cardiac patients are individuals who have been diagnosed with heart disease by
a
physician
(Dirksen
et al., 2010).
Cardiologist is the physician who
specializes
in the physiology
and care
of the
heart (Smeltzer et al., 2009).
Cardiopulmonary resuscitation (CPR) is the
process of externally supporting
the
circulation and respiration of
a
person whose heart has arrested (Dirksen,
O'Brien,
Lewis,
Heitkemper,
&
Bucher, 2010).
Carative is
the
act of caring (Potter & Perry, 2007).
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12
Chronic renal failure
is
the presence of kidney damage for at least three months,
with functional or structural
abnormalities
of
the
kidneys,
with
or
without
decreased
glomerular
filtration rate (Dirksen
et al.,
2010).
Critical care
is specialized care administered
to patients
who are
found to
be
too
sick
to
remain on a routine
hospital unit (Dirksen et al.,
2010).
Culturally
competent
care is a state in which the healthcare
professional
understands
and
attends
to
the total
context of the patient's situation (Spector, 2004).
Death
bed visions (DBVs) are
reports
of
visitations
from
deceased loved
ones
or
those
experiences that are in the spiritual or heavenly realm
(Critchley, 2008).
Diabetic ketoacidosis is caused by a profound
deficiency
of insulin and
is
characterized by high blood sugar, ketosis,
acidosis,
and dehydration (Dirksen et al.,
2010).
Dimethyltryptamine
(DMT) is
a drug that
has
psychedelic
properties
that is
found
not only
in
many
plants, but also in the
human
body, where its natural
function
has not
yet been identified (retrieved from
http://www.erowid.org/chemicals/dmt/dmt.shtml,
2010).
Direct-care
nurse is
a
licensed healthcare
provider
who provides comprehensive
holistic care
to
patients
(DeWitt, 2009).
End-of-life
experiences (ELEs)
are
experiences that are reported
by
individuals
prior to death
(Fenwick,
Lovelace,
&
Brayne, 2007).
Emergency department is
the triage area of a hospital (Potter
&
Perry, 2007).
Emergency
medical
technician (EMT) is a
specially trained individual who
attends to the
care
of individuals outside
of
a
hospital setting
(Como, 2006).
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13
Graves' disease
is
a
condition that involves the hyperactivity of the thyroid gland
with
a
sustained increase in synthesis and release
of
thyroid hormones (Dirksen et al.,
2010).
Holistic care is
a
method of providing care to
a
patient and family that considers
spiritual, physical, emotional,
social,
and economic needs (Como, 2006).
Hyperosmolar coma is a life-threatening syndrome that can occur in the patient
with diabetes mellitus who is
able
to produce enough insulin to prevent diabetic
ketoacidosis but
not
enough to prevent severe hyperglycemia, osmotic diuresis, and
extracellular fluid
depletion
(Dirksen et al., 2010).
Hypoxia is
decrease
of
oxygen to vital organs or
body
tissues resulting
in
physiological
deterioration
(Leifer, 2007).
Ibogaine is a substance found in a number of plants that
has
been used typically in
rituals and medicinal
purposes
and
most
recently
has been studied
as a potential
drug to
arrest drug addiction
as it relates
to
alcohol,
cocaine,
heroin,
and methadone
(Physician's
Desk
Reference, 2010).
Ketamine
is
a
drug that
is
administered
at low
doses and upon emergence from
anesthesia that produces changes
in
mood
and
body image
as well as
hallucinations
(Physician's Desk
reference,
2010).
Knowledge is
belief
that an individual ascertains to
be
truth (Flew, 1977).
Licensed nurse is
the
first-line licensed healthcare professional who provides
direct
patient
care under the scope of practice as identified by
a
state board of nursing
(Harrington
&
Terry, 2009; Texas
Board
of Nursing,
2009).
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14
Medical intensive
care
is a
specialized
critical care area
designed for
a variety of
patients
who are too
sick
to remain
on a
routine hospital
unit
(Como, 2006).
Multidimensional phenomenological-spiritually-based experience is
a
transcendental experience that includes time, space, and the
physical
environment
(Watson, 2010).
Myocardial infarction
(heart
attack) is lack of oxygen resulting in damage to the
heart
muscle (Perry
&
Potter, 2007).
Near-death
experience
is
a
spiritual event encompassing one
or
more
of
15
attributes at a
time of death
or
with
a
close
brush
with
death.
These include: (a)
indescribable knowledge,
(b) hearing of
one's death,
(c)
peaceful sensations, (d)
unusual
sounds,
(e)
out-of-body experience, (f) a tunnel,
(g)
ghostly
spirits
of light,
(h)
introduction
to
a supreme being
of
light, (i) life
review,
(j) border of
no
return, (k)
returning to the body,
(1)
informing others,
(m)
personal life adjustments after the
experience, (n)
attitudes toward
death
and
dying,
and (o)
collaboration
of
the experience
(Moody, 1975, 1988). The terms near-death experience, NDE, near-death phenomenon
and near-death phenomenon event, for the purpose of
the
study, were used
interchangeably.
Neurological system is an extensive physiological system of the body that
provides for
brain function,
thought,
speech, vision,
and
movement
as well as
physiological control of the human body (Estes, 2010).
Nonjudgmental therapeutic communication is the foundation
of
developing
a
positive nurse-patient relationship (Videbeck, 2008).
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15
Nursing faculty includes nursing instructors who
teach
or precept entry-level
nursing students in a variety of nursing curriculum. Nursing faculty, for the purposes of
the study,
was
defined as nursing
educators
who are members of the National League of
Nursing (NLN).
Palliative
measures
are
those
that provide comfort, but
that
are
not curative in
nature,
for
patients who
are
dying (Potter
&
Perry, 2007).
Perceptions
are actual human sensory experiences that
an
individual encounters
Flew, 2007).
Perspectives are
perceptions
(Marshall & Rossman, 2006).
Radical surgery typically results in surgery of
a nature that
is
disfiguring but
necessary
for
survival (Como,
2006).
Recreational
drugs are
drugs or
chemicals
that
have the potential to alter
an
individual's perception of reality (Stuart & Laraia, 2005).
Reflex anoxic seizures
(RAS)
is a seizure disorder occurring
in
children that may
be triggered by sensations of pain
or
fear (Blackmore, 1998).
Respiratory
arrest is cessation of breathing (DeWitt, 2009).
Stroke
is blockage of blood
flow
to
the
brain resulting in neurological damage that
may
be
temporary or permanent
(DeWitt,
2009).
Thoracic pain is pain in the region of the chest, typically associated with a cardiac
or pulmonary
focus
(Perry
&
Potter, 2007).
Tonsillectomy is the surgical removal of
tonsils
(Linton, 2007).
Terminal
state
is a physiological state in which there is no basis for recovery
(Feldman,
2008).
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16
Limitations of the Study
The study was
conducted using
a non-probability sample of nursing faculty who
are
members of
NLN.
Thus, external validity was limited to nurses who
are
members of
that
organization.
Assumptions of the Study
The study has
several
assumptions.
First, it was
assumed that
the nursing
faculty
had
experience
as
a deliverer
of patient care
but
may
not have
cared
for patients
and
families who have reported NDEs
or
DBVs. Second,
it
was assumed that
the
nursing
faculty were willing participants in the study. Third,
it
was assumed that nursing faculty,
based
on the
results
of the study, would
be open
to the possibility of
introducing
the
topics of NDEs and
DBVs
into the nursing curriculum.
Organization
of
the Study
The chapter has provided an introduction to and an overview of
the
study.
Chapter
2
presents a review of the literature on
NDEs
and DBVs, including components
of NDEs and DBVs, life-span perspectives of NDEs, involving the pediatric,
adult,
and
elderly populations, assessment of knowledge of and
attitudes
toward
NDEs
from the
perspectives
of
health care
and
ancillary professionals, a scientific perspective of
the
reasons for
NDEs
and DBVs, and philosophical
and
theological meanings of NDEs and
DBVs.
Chapter
3
presents
the
methodology for the study, while Chapter 4 presents
both
the
quantitative and qualitative findings. Chapter 5 provides
a
summary of
the study,
followed by
a discussion, conclusions, and recommendations for nursing leadership and
for further research.
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17
CHAPTER
2
REVIEW
OF
THE
LITERATURE
Academically recognized
data search engines
(CINAHL Plus
with
Full
Text;
Health-Wellness Resource
Center; PsycINFO; ProQuest; EBSCO;
Religion &
Philosophy
Collection and
Google
Scholar)
contained little research on NDEs
and DBVs,
particularly in regard
to knowledge
and
attitudes
of nursing faculty
regarding near-death
phenomena.
The empirical studies that were found used
quantitative
methods to evaluate
the NDEs
of patients. Few
studies
were found that concerned patients
and
family
members reporting DBVs. The majority of articles reviewed were qualitative-driven
anecdotal accounts that
focused
on individuals having
had NDEs.
One
qualitative article,
however,
focused on
the
perspectives of healthcare professionals
toward
DBVs. No
articles,
however, were found assessing knowledge and attitudes
of
nursing faculty
toward
NDEs
and DBVs.
Based on the relevant literature that
was found, the
review is organized as
follows: (a) components of NDEs and DBVs; (b) life-span perspectives as seen in
anecdotes of NDEs;
(c) anecdotes of DBVs; (d) knowledge and attitudes of
healthcare
professionals and other paraprofessionals toward NDEs;
(e)
scientific basis for NDEs
and
DBVs;
and (f) philosophical and theological meanings
of
NDEs and DBVs.
The
chapter
concludes
with a summary.
Components of Near-Death Experiences and Death Bed Visions
The term
near-death experience was
first
used
by
Moody
(1975)
and has
been
described
by
millions
of
individuals around the
world.
Duffy and
Olsen (2007)
emphasize the descriptive
components
of
NDEs. As
described
by
patients,
NDEs
include
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(a) a sense of separation from the
physical
body; (b) a tunnel of
light;
(c) meeting
deceased
relatives, friends, and
spiritual
entities;
(d) life
review; (e) a sense of peace;
and
(f) returning to one's body, knowing that the experience was real. Duffy and Olsen
provided no statistical information, only reports of NDEs of patients.
Ring (1980) laid
the
foundation for
the
measurement of the depth
of
NDEs, with
the
Weighted Core Experience Index (WCEI). Ring identified
10
of
Moody's
previously
identified components of NDEs but lacked statistical data that would empirically support
near-death
research.
Greyson (1983), attempting to bring legitimacy
to
the scientific investigation of
NDEs, developed the Near-Death Experience Scale, which incorporates statistical
reliability
and validity
in
measuring core components encountered by near-death
experiencers
(NDErs). The final Near-Death Experience Scale comprises 16 items,
further divided
into four
clusters: cognitive,
affective,
paranormal,
and transcendental.
Each cluster was analyzed utilizing inter-item correlations.
Greyson's
sample size
consisted
of
67
individuals
who had reported 74
separate NDEs. Test and
retest
methodologies
were
employed.
Greyson's
(1983) findings revealed that the Near-Death Experience Scale was
highly correlated
with each
of the four clusters,
with
the highest
correlation
found
with
the
transcendental component
(r
= .83). Internal consistency for
scale
had a
Cronbach's
alpha
of
.88. Error variance due to content sampling was determined
by
utilizing split-
half
(odd-even) reliability quotients,
yielding
an r = .84 and
a
Spearman-Brown rho =
.92, indicating
strong correlations
between patients'
NDE accounts. Criterion
validity
of
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19
the
Near-Death
Experience Scale was based on the correlations determined by Greyson
and as compared to those found for Ring's
(1980)
WCEI.
Morris
(1998) interviewed 12 patients
(6
men and 6 women), who had
a
mean age
of 48.1,
with an age
range of 24
to 73 years old.
Morris
utilized Greyson's
(1983)
Near-
Death
Experience
Scale in combination
with
Ring's (1980) WCEI
to
understand the
depth of the
patients'
NDEs.
Morris found that patients reported
similar components
or
experiences as those
reported
in the
Moody
(1975),
Ring
(1980), and Greyson
(1983)
studies. The patients' descriptions of their NDEs were also similar to those reported by
Duffy
and Olsen
(2007).
Lange, Greyson, and
Houran (2004) studied
NDEs, using the Rasch Scale of
Validity, with a sample of 292 (113
males
and 179
females),
with a mean age of 50.8
years. Lange et al. found that those patients who falsely report having NDEs were able to
be singled
out from
those patients who had an actual near-death
experience.
Additionally, findings suggest near-death experiences appear to have
a
basic core of
components previously found by Moody (1975), Greyson (1983),
and
Ring (1980).
Fenwick and Fenwick (2008) found that the differences between
NDEs
and
DBVs
is that an NDE
involves
an actual
event whereby
the experiencer
clinically
dies,
whereas
during
a DBV, the
individual may be near death
but has
not actually experienced clinical
death.
Wills-Brandon (2003b) identified
DBVs as "spiritually
transformative
experiences"
having significant life-changing potential for
patients and families.
Stafford
(2008) explained that DBVs produce
a
sense of comfort for patients and families in their
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20
pointing to
an afterlife.
Composite descriptions
of
DBVs
revealed similar
characteristics
across social, cultural, ethnic, sexual, and
religious
lines.
Life-span Perspectives of Near-Death Experiences
The review of literature contained many anecdotal accounts, from the very
young
to
the very old, of
individuals
who had an NDE. A sample of
their reports,
presented
from the young to the old, is included below.
Pediatric
Population
Morse (1983) reported
an
event whereby
a 7-year-old
girl experienced an
NDE
during
a
freshwater
drowning. The
girl
was
resuscitated, only
after extensive CPR
and
subsequent
intubation, and
was transported
to
the local hospital,
where Morse (an
emergency
room physician) attended to her.
Two weeks
after
the
near-drowning
event,
Morse followed up with the young girl, who presented the following account.
The girl remembered
being
in the water and
knowing that she
was dead. The
next
event that the girl recalled
was that
of traveling through
a
tunnel.
Becoming
frightened,
the girl described a
woman
(Elizabeth) who
came to her. The
girl described
Elizabeth
as
a tall
individual having bright yellow hair.
The
girl said that
Elizabeth
walked her up
to
what was believed
to be Heaven's front
door.
Although not
actually
seeing
past
the door,
the girl reported meeting deceased relatives and adults waiting
to
be reborn.
The
girl
described meeting Jesus, who offered her the option
to
return
to
mortal existence.
Morse, Conner,
and Tyler (1985)
interviewed pediatric
patients
reporting
unusual
events
during the time of
cardiac
arrest.
Below
are abbreviated
accounts
of
their
experiences.
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21
A 6-year-old boy was admitted to
the
hospital for a dual surgical procedure
(tonsillectomy
and adenoidectomy). The boy, while
under
anesthesia,
went
into cardiac
arrest. The boy
had a
clear
recollection of
the NDE
during
the time
of arrest, citing
an
out-of-body experience
in which he
found himself
perched
above, watching
the
resuscitation, then traveling through a multicolored
lit
tunnel,
all
along feeling intense
peace.
An
8-year-old
girl, with
a
history of Graves'
disease,
was
admitted
for
diabetic
ketoacidosis and a hyperosmolar coma. The
girl
arrived
at the
emergency room awake
but
then became
unresponsive
and
comatose
for
over
24 hours. The girl described
three
separate events during the time of the coma. The first event occurred
while
in the
emergency
room.
She described floating
above,
watching the
events
of the resuscitation.
The second
event
involved seeing a teacher and classmates surrounding her, and singing,
wishing
the
girl a fast recovery. The girl, apprehensive when describing
the
third event,
drew pictures describing a frightening NDE.
A
16-year-old
boy,
diagnosed
with chronic
renal failure, was admitted
to
the
hospital
with abdominal and thoracic pain, requiring cardiac bypass surgery.
Complications
arose during
the surgery, resulting in arrest, requiring several minutes of
CPR.
The teenager expressed having traveled to Heaven, describing
the
experience as a
peaceful time,
and talked about walking up
a darkened
staircase
that
had
a
brilliant light
at the top. A deceased brother
told
the teenager
that it
was not yet
time to
die.
Adult
Population
Ernest Hemingway reported having had an NDE while serving with
the
Red Cross
in
Italy.
An exploding
mortal shell resulted in shrapnel being scattered throughout
his
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entire body and
tearing
his
right knee. Recovering in
a
military
hospital,
Hemingway
later
expressed having an out-of-body experience
and
traveling on a spiritual
quest,
describing
his
encounter
as one that
allowed reflection on death
and
dying. Hemingway,
no longer
fearing
death after the
NDE,
felt that dying could be one of the easiest things
to
experience
(Vardamis
& Owens,
1999).
Buddy
Farris, a 26-year-old Virginia State Trooper, experienced a
deep
NDE
Thanksgiving eve night in 1979. Assigned
to
patrol the Interstate
95
corridor from
Richmond, Virginia,
to
Washington,
DC,
Trooper Farris had stopped a speeding
car.
While
he
was standing at
the
back
of
the stopped vehicle,
a
second
car
(driven
by
a
drunk
driver) smashed into the back of the stopped car.
Mr. Farris was declared dead at the
scene
of the
accident and was transported
to
the Richmond morgue
(Appendix
A).
Elderly Population
Ring (1982) reported several
accounts
of
NDEs
among
the elderly.
A 60-year-old
woman who suffered
a
myocardial infarction (heart attack) recalled experiencing total
peace during
her
NDE. A
70-year-old woman, during
a
respiratory arrest, described an
out-of-body experience and seeing
a
tunnel with
a brilliant
light
being
emitted.
Sabom
(1982),
a
cardiologist, conducted research
on
cardiac arrest patients,
finding
many
reporting NDEs.
Two
of his accounts are presented here. A 60-year-old
woman, who was admitted for
severe
back pain, suffered cardiac arrest
and described
watching
the events
of resuscitation
at the
bedside
from above.
A 60-year-old man,
during resuscitation, recalled being outside of his body but then experiencing
a
powerful
force, likened to
a
giant magnet, pull him
back inside the body.
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23
Anecdotal accounts
demonstrate that
NDEs occur more regularly across the
life
span
than
what was
once
thought (Ketzenberger & Keim, 2001). According
to Brayne
et
al.
(2006), near-death
events
have not gained acceptance in medical or social circles
due
to
cultural fears
and taboos.
Anecdotal accounts of DBVs are less reported in the
literature
but
have significant
meaning
for
individuals who
are close
to
death
as well
as
family members who are working
through the
grieving process.
Personal Anecdotes
of
Death
Bed
Visions
Wills-Brandon (2003a) noted
that, as
a teenager, she experienced
a DBV during
the passing
of her mother,
who was hospitalized the last week of
her
life.
The
spiritual
entity that
came to
Wills-Brandon
was
that of her mother in
the
process of
dying.
The next account was
told to
the researcher by the
daughter
and son of
a
patient in
the
Medical Intensive
Care
Unit at a major hospital in
San Antonio, Texas.
The 70-year-
old patient and her children had been told earlier that day by the physician about the
terminal state of
her condition.
They (patient, daughter,
and
son) decided
not to have
artificial
means
instituted to keep her alive but
rather requested that comfort/palliative
measures be administered.
The patient would
awaken
at intervals
and,
for the most part,
was
lucid (Appendix
B).
A south
Texas
college manager of technology
support
shared
the
DBV that her
dying mother experienced (Appendix C).
Attitudes toward Near-Death Experiences
The review of literature revealed
few studies
relevant
to
the knowledge of
NDEs
possessed by healthcare workers or paraprofessionals. Literature was found, however, on
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attitudes toward
NDEs
by other groups, including the clergy, hospital nurses, hospice
nurses,
physicians, and psychologists.
Clergy's Attitudes toward
Near-Death
Experiences
Royse
(1985)
investigated the attitudes of 174 clergy toward
NDEs. A
total of
110
members of the clergy,
who had attended
a death
and
dying class,
served
as
participants.
The
participants
were predominantly male, with
a
mean age of 39 years,
who represented 20 denominations. The results indicated that 13% of
the
participants
reported
having
had
an NDE, and 71% reported having parishioners
who
experienced an
NDE. Additionally, 72% of the participants approved discussing the topic of NDEs with
parishioners.
Hospital Nurses'
Attitudes
toward Near-Death
Experiences
Oakes (1981) interviewed
30
critical care and emergency department nurses in a
major metropolitan health care
facility
in regard to their attitudes toward anecdotal
accounts of
NDEs.
Their
responses
were
mixed, ranging
from
disbelief
of the
existence
of
NDEs to a desire
to
report
the investigator
to the
hospital
administration for
conducting
this type
of interview in
the
hospital. Other
participants
expressed interest in
learning
about near-death experiences (NDEs).
Thornburg (1988) developed a tool with the three subscales of knowledge,
attitude, and caring
for
a patient
who had
experienced an
NDE, to
measure knowledge
and
attitudes
of
nurses toward NDEs. As determined through
a
pilot study, the tool
developed by Thornburg
demonstrated
adequate reliability of the
three
subscales of .83,
.84, and .81, respectively. Content validity was established by experts
in
the disciplines
of sociology, psychology,
and nursing.
The results demonstrated that 95% of
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respondents had heard of NDEs. Attitude
responses
ranged from
fascination
to utter
disdain
and disbelief
as
to how knowing about near-death phenomena
could
help
in the
care of patients.
Using Thornburg's (1988) questionnaire, Cunico (2001) surveyed 750 Italian
nurses and had a 63% response rate. Findings revealed participants reporting personal
NDEs. Compared to other studies that utilized Thornburg's questionnaire, the Italian
nurses did not
have
as much
knowledge
about NDEs,
and
their attitudes
were
less
positive than were those of their Western counterparts.
The findings revealed a desire to
have
professional development
on
the topic
of
NDEs.
Hospice Nurses' Knowledge of and Attitudes toward Near-Death Experiences
Utilizing Thornburg's (1988) questionnaire, Bamett (1990) performed a state
wide study of
Virginia's
hospice nurses, receiving a 54% response rate for
the
111
questionnaires distributed. The results indicated that hospice nurses in Virginia are
knowledgeable about NDEs, with 52% able to correctly answer 12 or
more
of
the
23
knowledge questions. All nurses demonstrated a positive
attitude
about NDEs and
indicated interest
in
learning more about
the
topic
as
a mechanism to
discuss
death and
dying with hospice
clients
and family members (Barnett, 1991).
Physicians' Knowledge
of and Attitudes
toward
Near-Death
Experiences
Barnett (1991) assessed knowledge and attitudes of physicians toward
NDEs.
Although she distributed
1275
questionnaires to physicians, only 143 of
those
returned
were usable. Many more physicians mailed back partially completed surveys (for
reasons not identified) and were not included in the final statistical analysis. The
majority of the participants were male (88%),
with
a Protestant or
Catholic
religious
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affiliation,
and 51%
reported
caring
for clients having
had NDEs.
Additionally, 13%
of
the study participants reported having had an NDE. Most of the physicians exhibited
knowledge
of the
components of
an NDE, and the majority
(65%)
indicated having a
positive attitude toward patients'
NDEs
and
welcomed staff
development's
focusing on
the topic of NDEs, believing NDEs should be
offered
in
a
didactic
curriculum to
healthcare providers
(Moore, 1994).
Psychologists' Attitudes toward Near-Death Experiences
Walker
and
Russell (1989) surveyed 117 psychologists, utilizing Thornburg's
(1988)
questionnaire.
Findings
revealed
high levels
of positive attitudes toward
NDEs.
Additionally, 7% indicated
having
had
an NDE, and 19%
reported having provided
counseling for individuals
expressing
having had
NDEs.
Attitudes toward Death Bed Visions
Fenwick et al.
(2007),
in the
only empirically
driven study found on DBVs,
looked at implications for palliative
care
in relation
to
end-of-life experiences (ELEs).
Based on
interviews
with the
palliative
care
team, DBVs, a
sensation
of
leaving the body,
deathbed coincidences,
hallucinations, and dreams
were
the themes
revealed by
the
participants interviewed.
The
findings revealed that ELEs are frequently reported but that medical
practitioners have
been slow in
acknowledging
the
significance of
these
experiences for
patients and their families. The researchers speculated that
the
lack of recognition of
ELEs might be
related
to
a lack of knowledge about
DBVs on the
part of healthcare
workers.
The results
also
suggested that
ELEs
have
components similar to NDEs and
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27
DBVs. The researchers recommended professional development on near-death
phenomena.
The literature review has shown the need for healthcare professionals and
paraprofessionals to have knowledge and to be accepting of NDEs and DBVs. As such,
these are recommended
topics
for professional development.
Scientific Basis for Near-Death Experiences and Death Bed Visions
A number
of articles
focus on drug-
or
medically-induced states that produced
experiences similar to
NDEs.
Research on various medications and drugs as well
as
medical conditions that
can result
in
NDEs
is presented below.
Ketamine
Jansen
(1997),
who has extensive experience with
the
administration of Ketamine,
a substance used
to produce
altered
states
of
consciousness, reported patient accounts
that
resembled NDEs.
A
sense
of
peace, a common
component
of
NDEs, was
the
only
component not reported by participants who had received
Ketamine.
Ibogaine
Blanchi
(1997)
had
a
different perspective on
the
pharmacological
action of
Ketamine, believing
that it
is
more
of
a
hallucinogen than
a
medication. Blanchi, instead,
examined the role
of
Ibogaine,
an alkaloid
substance extracted from
the
Tabernantle
iboga plant,
native
to
Central
Africa. Blanchi
found
many
tribes
in
Central
Africa,
including the Pygmy, Bakota, and Bakwele
tribes of the
Congo, utilized Ibogaine in ritual
ceremonies involving rites of passage. The tribal leaders believed that ingestion of an
Ibogaine derivative would invoke, in members of
the
tribe, visionary views of
the
meaning of life and death. Blanchi revealed that
the
properties of the Ibogaine plant act
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on
the dopaminergic and
serotonergic
systems
of
the
body, providing
anti-addiction
agents that could
help in the treatment of addiction
to
heroin,
cocaine, amphetamines,
nicotine, and alcohol.
Blanchi found
that individuals
who ingested
Ibogaine derivatives
reported
experiences
similar
to
those reported by
individuals
who had experienced
NDEs.
Dimethyltryptamine
R. Barnett (personal communication, May 29,
2009)
experienced an NDE after
inhaling
Dimethyltryptamine (DMT), a naturally
occurring compound
found in
many
plants
and
animals
(including in the
human
brain), which has
been
used
in certain mystic
tribal
religions to
bring
about vision quests
(Appendix D).
Anoxic States
Blackmore (1998) studied the role
that hypoxia
plays in
triggering NDEs among
children. Blackmore sent 112 questionnaires
to children
who had suffered
cardiac
arrests,
resulting from a condition
known
as
reflex
anoxic seizures
(RAS).
The
results
indicated
that 24%
reported having had some
components
of an
NDE,
including having
an out-of-body experience, being in
a tunnel,
and
seeing
multicolored
lights.
Cardiac Arrests
Schwaninger, Eisenberg, Schechtman, and Weiss (2002) conducted
a
survey of
cardiac
arrest
patients
from April 1991
through
February
1994, following 174 patients
who
had
experienced cardiac arrest, of whom 55 survived
the experience.
Of the 55
individuals,
30 were interviewed, and
7
reported having had
an NDE.
They described
a
feeling of comfort,
peace, and detachment
from the body, with
no report
of pain.
Schwaninger
et
al.
stated
that
NDEs are gaining acceptance in
the
scientific medical
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community
as
important life-changing events
in the lives
of patients and
families
of
patients.
Quantum Biomechanics
Beck and
Colli (2003)
introduced
a
theory of quantum hologram research
providing evidence of instantaneous
empathic
memory recall,
supporting
the occurrence
of life reviews in patients having had NDEs. The researchers investigated
the
relationship of the microscopic neuro-microtubules found in the
brain,
which create
a
person's memories. The
researchers believe that neuro-microtubules are
key components
of
human
consciousness,
providing
a link to unlimited memory
storage capacity
within
the
human
DNA.
As such, these neuro-microtubules provide an explanatory
mechanism
for
the life-review process seen in NDEs.
Philosophical
and
Theological Meanings
of
Near-Death
Experiences and Death Bed Visions
Moody (2007)
discussed
the connection between NDEs
and ancient
Greek
philosophy. Moody noted that,
while
attempting
to
gain knowledge
of
the afterlife,
ancient
Greek philosophers would isolate themselves, venturing into otherworld
environments. The
philosophers,
evoking spirits of the dead, would have out-of-body
experiences. The
culmination
of the early
philosophers'
ventures resulted in uncovering
nine
concepts relevant
to
understanding the meaning of life
after
death and that still have
an influence
today.
Unimaginable
phenomenal
experiences
Relationship between mind and
body
Spiritual visions of deceased individuals
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30
Reincarnation
of souls of
the
dead
Past mortal behavior determines future spiritual existence
Curiosity of spiritual existence after
a
loved one's death
Empathy
for those
dying and
those
who are grieving
Life after death construed as non-literal dimensions of the meaning that supports
those
concepts and components
experienced
by those who
have
a
close brush
with
death
The
afterlife as
the final great mystery
Bain (1999) explored
the parallels between Gnostic Christianity
and NDEs,
supporting
previous
research showing similarities between what near-death experiencers
report and what has been expressed in religion.
Bain's findings support
previous
research
showing similarities between what near-death experiencers report
and
what
has
been
expressed in religion
chronicles, including
the Holy Bible; the
Tibetan Book
of
the Dead;
the Koran; the Hindu Upanishads; and Egyptian, Zoroastrian, and Babylonian scrolls.
The Bible
contains
a
description of another place that one
goes to
as death ensues:
These all died in faith, not having received
the
promises,
but
having
seen them
afar off, and were persuaded of them, and embraced them, and confessed that they
were strangers and pilgrims
on
the
earth.
For they
that say such
things
declare
plainly that
they
seek
a
country. And
truly,
if they had been mindful of that
country
from whence
they
came out,
they might have had opportunity
to have
returned.
But
now
they desire
a
better
country,
that is, heavenly: wherefore God
is
not ashamed to
be
called
their God:
for
he hath prepared
for them
a city
(Hebrews
11: 13-16).
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31
In another passage of the Bible, individuals on
the
brink of death express
indescribable knowledge (a component
of
the NDE) as follows:
I know a man in Christ who fourteen years ago was caught up to
the
third heaven.
Whether
it
was
in the
body
or out
of
the
body I
do
not knowGod knows.
And
I
know that
the
manwhether in
the
body or apart from
the
body I do not know,
but God knowswas
caught
up to paradise.
He heard inexpressible things, things
that man is not permitted to tell (2 Corinthians 12:2-4).
Based on biblical scriptures, the Christian faith believes in an afterlife, supporting the
construct of
what
occurs
with NDEs
and DBVs.
Murphy (2001) found similarities of NDEs
with the
experiences
of
Buddhists who
have experienced a brush with death. One of
the most
striking similarities relates to
the
out-of-body experience and the meeting of a supreme spiritual being. In
the
context of
the
Buddhist religion, the supreme spiritual guide identified as Yama is
the
entity who
escorts
those
who are worthy to meet
the
Lord Buddha.
Green (1998) studied the similarities found between aspects of shamanistic
journeys and spiritual out-of-body experiences occurring with NDEs. The researchers
described shamanic journeys in
which the
individual passes into an altered
state
of
awareness
and
experiences out-of-body events.
The
belief
held by
practicing Shamanists
is
that, through
the
out-of-body experience,
one
goes on a
vast
journey through other
dimensional worlds, populated
by
the
spiritual dead. During
the
journey,
the
shaman
experiencer forms relationships with spiritual beings, learning how to help individuals in
the
mortal world to have more spiritually enriched lives.
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32
Slattery
(2009) examined
the
spiritual life-force found within
all
individuals.
Slattery
attempted
to uncover the
meaning
of
consciousness. Slattery studied Native
Indian beliefs and
compared
rituals from Eastern mystic religions and Western science
that pointed
to a
physical and
a
spiritual realm of existence.
Flew (2007),
a
passionate atheist for most of his life, became
a
believer in
God
in
the last six years
of
his
life
(Sadly, he
died
April 8, 2010, one day prior to this
dissertation proposal
defense).
Flew stated:
What
I
think the
DNA
material has done is that it has
shown,
by the
almost
unbelievable complexity of the arrangements which
are needed to
produce
(life),
that intelligence must have been involved
in
getting
these
extraordinarily diverse
elements
to
work together.
It's the
enormous
complexity of the number of
elements
and the
enormous
subtlety of the ways they work together. The meeting
of
these two
parts at
the
right time
by chance
is
simply minute . . . which
looks to
me like the work of intelligence
(p.
75).
Understanding and accepting the religious and spiritual beliefs of
others
can
assist
in the provision of culturally competent and
holistic
care. Abrums (2000) noted that
nurses
can
become uncomfortable addressing
the
spiritual
needs
of
families
and patients
during times
of
death. This may
be
because nurses lack
certain
spiritual
carative
skills to
provide empathy
to
patients who experience NDEs and DBVs.
Abrums (2000) conducted
an
ethnographic analysis, based on interviews, of
members of
a
small African American
church
to explore the meaning of death and
grieving. Abrums found that the study participants had particular ways of managing
death, whether
the death was
that
of
an adult or
child. Participants
had strong
beliefs
in
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the afterlife, and during times of death, the church members would come together in
praise of
the dying one's
life,
while
supporting
his
or
her
journey forward
to
the next life
and
supports a
previous account reported (C.
Perkins,
2009,
Appendix
C).
The
findings
indicated that religious African
Americans
routinely employ ways to
support
one
another
during the death process, providing holistic
care and support to individuals
experiencing
NDEs and
DBVs.
Summary
The
review of literature has provided a
summary
of quantitative and qualitative
research in
the field of NDEs
and DBVs.
Greyson
(2006) noted
the
importance of
understanding
NDEs and related phenomena
such
as
DBVs not only
from a
philosophical
perspective but also
in terms
of
the care provided
by healthcare professionals, stating that
NDEs and DBVs are life-changing
experiences with
significant
meaning
in the lives of
patients
and
families.
In
this
regard, Cole
(1993) stated:
It
appears
important
to
demonstrate
the
profound psychological impact
such an
experience has on any individual, and to find out just how the doctors and nurses
are
dealing with such
patients and
what aspects of
nursing
care
could
be
improved
(p. 157).
Our responsibility as healthcare
professionals
is
to
ensure that
the
care that is
provided is both transforming and transcendental. The care also should support
a
comprehensive, culturally-competent
holistic
philosophy of
care
for all who become
sick
and
who
are on the
brink
of
death. The philosophy of care should be seen throughout the
hospital experience
and
when
a patient
is discharged
to
home
health and/or
hospice
care
services and should incorporate the treatment of
family
members
(Quill,
1999).
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34
CHAPTER 3
METHODOLOGY
Introduction
The purpose of the study was to
assess
knowledge, attitudes, and views of nursing
faculty
towards patients
with perceived near-death experiences and death
bed
visions.
The secondary purpose was to explore perceptions
of nursing
faculty toward patients with
near-death visions
and
death bed visions. The following research questions were
investigated:
1. What do nursing faculty know about near-death experiences?
2. What are
the
attitudes of nursing faculty
toward
near-death experiences?
3. What
are
the perceptions of nursing faculty regarding near-death experiences?
4. What are the perceptions of nursing faculty regarding death bed visions?
Research Design
The study used
a
mixed-methods approach, utilizing both quantitative and
qualitative data drawn
from
an electronic questionnaire. The quantitative aspect provided
data
that were
measurable and amenable to analysis,
lending breadth
to
the study.
The
qualitative data, from
responses to
open-ended questions, provided rich,
detailed accounts
of reports of NDE and DBV experiences of patients, family, or others, lending depth to
the study (Creswell, Clark, Gutman & Hanson, 2003).
A triangulation-convergence approach to
data integration and analysis
was
used
for interpretation. The study triangulated findings from the quantitative and qualitative
portions
as a
means to develop valid and well-substantiated conclusions
about
nursing
faculty's
knowledge or and attitudes toward near-death phenomena (Creswell, 2005).
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35
Figure 2
top related