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When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening. Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care. This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life: Determining diagnosis and prognosis and communicating these to patient and family. Establishing clinical and personal goals. Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."
First published in 1982. Routledge is an imprint of Taylor & Francis, an informa company.
This volume is directed towards professionals who work in the fields concerning death and dying. These professionals must perceive the needs of people with cultural patterns which are different from the "standard and dominant" patterns in the United States and Canada. Accordingly, the book includes illustrative episodes and in-depth presentations of selected "ethnic patterns".; Each of the "ethnic chapters" is written by an author who shares the cultural traditions the chapter describes. Other chapters examine multicultural issues and provide the means for personal reflection on death and dying. There are also two bibliographic sections, one general and one geared towards children. The text is divided into three sections - Cross-Cultural and Personal perspectives, Dying, Death, and Grief Among Selected Ethnic Communities, and Reflections and Conclusions.; The book is aimed at those in the fields of clinical psychology, grief therapy, sociology, nursing, social and health care work.
The idea that suicide may be an acceptable, rational option is rarely presented in professional literature. However, recent events and developments forcefully demonstrate that mental health professionals can no longer ignore the possibility that people can make a rational decision to die. After introducing the concept of rational suicide, the book explores the changing views of suicide over the centuries. Common arguments against rational suicide are examined and rebutted.
"The book is well organized, well detailed, and well referenced; it is an invaluable sourcebook for researchers and clinicians working in the area of bereavement. For those with limited knowledge about bereavement, this volume provides an excellent introduction to the field and should be of use to students as well as to professionals," states Contemporary Psychology. The Lancet comments that this book "makes good and compelling reading....It was mandated to address three questions: what is known about the health consequences of bereavement; what further research would be important and promising; and whether there are preventive interventions that should either be widely adopted or further tested to evaluate their efficacy. The writers have fulfilled this mandate well."
For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.
First published in 1996. This new book gives voice to an emerging consensus among bereavement scholars that our understanding of the grief process needs to be expanded. The dominant 20th century model holds that the function of grief and mourning is to cut bonds with the deceased, thereby freeing the survivor to reinvest in new relationships in the present. Pathological grief has been defined in terms of holding on to the deceased. Close examination reveals that this model is based more on the cultural values of modernity than on any substantial data of what people actually do. Presenting data from several populations, 22 authors - among the most respected in their fields - demonstrate that the health resolution of grief enables one to maintain a continuing bond with the deceased. Despite cultural disapproval and lack of validation by professionals, survivors find places for the dead in their on-going lives and even in their communities. Such bonds are not denial: the deceased can provide resources for enriched functioning in the present. Chapters examine widows and widowers, bereaved children, parents and siblings, and a population previously excluded from bereavement research: adoptees and their birth parents. Bereavement in Japanese culture is also discussed, as are meanings and implications of this new model of grief. Opening new areas of research and scholarly dialogue, this work provides the basis for significant developments in clinical practice in the field.
What happens to consciousness during the act of dying? The most compelling answers come from people who almost die and later recall events that occurred while lifesaving resuscitation, emergency care, or surgery was performed. These events are now called near-death experiences (NDEs). As medical and surgical skills improve, innovative procedures can bring back patients who have traveled farther on the path to death than at any other time in history. Physicians and healthcare professionals must learn how to appropriately treat patients who report an NDE. It is estimated that more than 10 million people in the United States have experienced an NDE. Hagan and the contributors to this volume engage in evidence-based research on near-death experiences and include physicians who themselves have undergone a near-death experience. This book establishes a new paradigm for NDEs.
The death of a child is a special sorrow. No matter the circumstances, a child's death is a life-altering experience. Except for the child who dies suddenly and without forewarning, physicians, nurses, and other medical personnel usually play a central role in the lives of children who die and their families. At best, these professionals will exemplify "medicine with a heart." At worst, families' encounters with the health care system will leave them with enduring painful memories, anger, and regrets. When Children Die examines what we know about the needs of these children and their families, the extent to which such needs areâ€"and are notâ€"being met, and what can be done to provide more competent, compassionate, and consistent care. The book offers recommendations for involving child patients in treatment decisions, communicating with parents, strengthening the organization and delivery of services, developing support programs for bereaved families, improving public and private insurance, training health professionals, and more. It argues that taking these steps will improve the care of children who survive as well as those who do notâ€"and will likewise help all families who suffer with their seriously ill or injured child. Featuring illustrative case histories, the book discusses patterns of childhood death and explores the basic elements of physical, emotional, spiritual, and practical care for children and families experiencing a child's life-threatening illness or injury.
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine