The earliest American death workers had been members of other trades or occupational groups, and “undertaking” was largely a part-time job. In colonial America, most of the activities following a death were carried out by family members or friends. Funeral customs in the early years of the 20th century were tinged with Victorian era and post-Civil War practices. Infant, child, adolescent, and younger adult mortality was common and especially powerful influences on the emerging practices of that era. Funeral directors have been held to higher professional standards and have striven for more professionalism within the industry. An increasing number of professionals in the field are going on to graduate work or training in fields such as aftercare specialists, bereavement counselors, and as funeral celebrants. Many baby boomers may want a unique funeral experience. As they grew older, baby boomers increasingly questioned the traditional funeral.
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This chapter sketches out the brief rich history of modern “hospice” and “hospices”, concentrating on developments in the United States and the United Kingdom, and highlights the spread of influence and the adaptation of ideas in other cultures and jurisdictions. Hospice is both a service and a set of ideals; a way of doing and a way of thinking. Financial considerations remain central to thinking about the provision of hospice and palliative care in the United States. Skilled nurses, social workers, chaplains, and volunteers provide the kind of holistic care that is increasingly valued by older people. The paradox for the health care system is that the patient must be dying in order to get it. Medicare pays hospice a fixed daily rate. Hospice has a key role to play in current debates about care at the end of life.
While the home is generally reported to be the preferred setting to receive end-of-life care, and despite it being the wish of a majority of patients to die at home, hospitals are the place where most people die. A chain of events triggered by a panel discussion on death and dying in February 1973 at a local church led to Dr. Mount’s development of a palliative care service pilot project at the Royal Victoria Hospital, a McGill University-affiliated institution. The conclusions of this project were clear: the medical, emotional and spiritual needs of the terminally ill and their families were generally neglected in the delivery of health care. In many countries, the development of hospital-based palliative care services has been largely influenced by the fee-for-service system, a system that very often fails to provide support for the interdisciplinary team beyond physician reimbursement.
Modern hospice and palliative care is approaching a significant anniversary: In 2017 it will be 50 years since the founding of St Christopher’s Hospice. The hospice movement grew very slowly in its early decades, whereas during the last 20 years it has gained acceptance and is now viewed as an essential part of any complete health care system. The most common need for palliative care is cardiovascular diseases followed by cancer, respiratory disease, and a long list of other noncommunicable diseases. This chapter focuses on the global need for hospice and palliative care and the growing efforts to address the economic, political, and cultural challenges of bringing effective end-of-life care to the millions in need around the world. The National Hospice and Palliative Care Organization (NHPCO) is the largest membership organization for hospice and palliative care providers in the United States.
- Go to chapter: When Trauma and Loss Collide: The Evolution of Intervention for Traumatic Bereavement
This chapter explores the evolution of intervention for traumatic bereavement. Following some definitions and conceptual clarifications, it briefly sketches a noncomprehensive timeline of that evolutionary process. Traumatic stress refers to distress that is caused by a person’s experience of psychological trauma, in particular dying and death of the loved one. Traumatic stress can occur during and/or after the dying and death. The traumatic deaths as giving rise to traumatic bereavement go beyond the traditional ones from accident and disaster, suicide, and homicide. A relation between traumatology and thanatology may seem so obvious as to be a tautology, for almost all traumatic stressors encompass death or the threat of death. Up until 2000, there are six major concepts that seem especially noteworthy, foundational, and never to be forgotten by anyone practicing with traumatized. The chapter discusses these concepts briefly.
This chapter presents a narrative on the growth of literature and resource materials, research and education, and important concepts involving children and grief over the past decades. It traces a time that begins with the lack of words to address grieving youngsters to the present wealth of information on the many loss and grief issues young people face. The chapter highlights a major shift from television to modern digital technology that has helped anchor and disperse concepts, techniques, and materials important to bereaved children and families. Much has been written over the years concerning children’s concepts of death. The preoperational stage presents a child’s concept as including magical thinking, egocentricity, reversibility, and causality. In order to reduce anxiety and fear, it is essential for adults to become familiar with the following basic understandings about bereaved children. Deaths that cause shame or stigma can impede grieving and grief therapy.
This chapter reviews very briefly the major constructs used in the field of occupational stress: stress and distress, burnout and job engagement, and compassion fatigue and compassion satisfaction (CS) and describes some key findings for professionals, volunteers, and family caregivers. It focuses on what is known about what helps caregivers deal with their personal and job stress, current exciting interventions being done in the field of caregiving, and reflections on major challenges and hopes for future developments in the field. Stress and distress in caregivers is often referred to as psychiatric disturbance. Interventions to decrease stress, distress, burnout, and compassion fatigue and promote job engagement and CS involve the creation of a healthy work environment as well as individuals, whether professionals, volunteers, and even family caregivers, realizing the importance of developing self-awareness and self-care practices and integrating these practices into their lives.
This chapter examines the development and some aspects of the history of formal offerings of courses on death, dying, and bereavement at the college and university level in the United States and Canada. It provides examples of some of the early pedagogical resources that were created to support and foster death education initiatives, and sketches more recent developments as regards survey courses in this field, other death-related courses, and programs in thanatology. Survey or overview courses in death education are typically identified as “Death and Dying”, “Introduction to Thanatology”, or “Survey of Thanatology” courses. Instructors and audiences for these courses have come from such widely different backgrounds as counseling, funeral service, health education, nursing, philosophy, psychology, religious studies, social science, social work, and sociology. In recent years, programs in thanatology or the organized study of death-related topics have been developed at several colleges and universities.
The earliest writings of humans were essentially spiritual treatises on death. Humans have both the conceptual ability to recognize their mortality and the survival instinct to resist that knowledge. Spirituality remains an effective mechanism to resolve that paradox. This chapter explores what has been learned about spirituality in palliative and bereavement care considering the ways that spirituality affects health, coping with dying and bereavement, as well as critical issues in the delivery of spiritual care. Research has indicated that religion and spirituality can both facilitate and complicate responses to life-threatening illness and grief. Health professionals have long realized that religious and spiritual systems play a significant role in the ways that patients and their families make end-of-life. Because spirituality is so central as individuals and their families struggle with later life, it is important that holistic care include spiritual assessment.
Over the years, health care professionals from many disciplines have contributed to the knowledge base supporting palliative and end-of-life care. This chapter presents a brief description of the nurses who led the development of nursing as a profession as a context for other nursing leaders who contributed to the science and practice of palliative and end-of-life care. It describes nurse leaders whose sustained work influenced end-of-life care in seven major areas: uncovering and combating the conspiracy of silence, making meaning for children and adults as they live with the chronicity of a life-threatening illness, promoting team-based collaborative approaches to care, managing pain and symptoms of children and adults, integrating bereavement as part of patient-centered and family-focused dying care, conducting research, and educating nurses to improve care of people at the end of life.