Drama as an Experiential Technique in Learning How to Cope with Dying Patients and their Families

This paper discusses a teaching experiment in which participation and observation of a drama helped first year nursing students to consider ways of dealing with death and dying. Workshops included dramatised scenarios of critical incidents demonstrating different peoples' experiences of the death of a fictional patient in hospital. Two nurse teachers performed a two-part drama about the experiences of a patient just diagnosed with terminal cancer. Live performances were presented to large groups of students and followed by small group discussions. Drama as a teaching method was well received, and the combination of drama and group discussion was considered very effective by students, who requested more similar sessions. Drama appears highly satisfactory for achieving learning in the affective domain, and can be added to teaching methods for improving communication skills and coping strategies with nursing students who will be caring for the dying. However, further research is necessary.     

Death Education and Counseling: A Survey

A survey of counselors and counselor educators was conducted to assess information and attitudes with regard to death education, training in death and dying, and the appropriateness of dealing with death in the schools. Results showed that an overwhelming majority of both the responding counselors and the counselor educators felt that school counselors should work in this area (both counseling and death education). Although both these groups recognize the need for training in death and dying, little is presently being done to help counselors acquire the necessary skills and awareness to work in the area of death and grief. Recommendations for changes are included.     

专业硕士生生活事件与心理健康:消极应对的中介效应

为初步探讨专业学位硕士研究生生活事件与其心理健康（焦虑、抑郁）的关系以及应对方式在此过程中的中介作用,以309名湖北省某综合性大学在读专业硕士研究生（研一和研二）为对象,采用研究生生活事件量表、简易应对方式问卷、焦虑自评量表（SAS）以及抑郁自评量表（SDS）进行测试。结果表明,专业学位硕士研究生生活事件、应对方式与焦虑、抑郁状况之间相关性显著。其中,生活事件得分与消极应对呈显著正相关,焦虑和抑郁得分与生活事件得分也呈显著正相关。中介效应分析显示,消极应对在专业学位硕士研究生生活事件和心理健康（焦虑、抑郁）之间起到部分中介作用。     

Coping strategies and psychological well-being among teacher education students

The coping strategies used by students play a key role in their psychological well-being. This study examines the relationship between coping strategies and psychological well-being in a sample of 98 undergraduates aged between 19 and 42 years. Coping strategies were evaluated by means of the CRI-A (Moos, 1993), while psychological well-being was assessed using the BSI (Derogatis and Spencer, 1982). The results show a relationship between coping style and psychological well-being. Approach coping strategies as problem solving in teacher education students had a beneficial effect on symptoms of depression, phobic anxiety and overall level of psychological distress. In contrast, cognitive avoidance coping are associated with greater presence of psychological symptoms indicating distress. And behavioural avoidance strategies (search for alternative rewards and emotional discharge) were associated with negative psychological well-being. Coping strategies may help to reduce psychological distress in university students. Specifically, approach-oriented coping is associated with positive scores for psychological well-being, and avoidant emotion-focused coping—above all, behavioural avoidant coping—may be a strong predictor of psychological distress.     

Preliminary study on the role of alternative educational pathways in promoting the use of problem-focused coping strategies

Coping styles are generally considered to be environmentally driven. Up to now, research has mainly focused on family influences. However, some studies underline the effect of educational settings on the development of problem-focused coping strategies. Consistently with previous reports on the enhancement of autonomy and problem-solving in alternative schools, and the relationship established by self-determination theory between autonomy-supportive climates and positive coping, we hypothesized that alternative school students develop more problem-focused coping styles. This hypothesis was tested on 80 traditional school students and 50 alternative school students (Steiner, Montessori and New schools), during their last secondary school year, using the Coping Inventory for Stressful Situations (Endler & Parker, 1990a). We also assessed psychological factors which can influence coping styles measures (anxiety and depression), using the State-Trait Anxiety Inventory (Spielberger, 1983), and the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). The proportion of problem-focused coping strategies was compared in traditional and alternative settings, adjusting for potential confounding factors, using logistic regression. Results show that the proportion of students using predominantly problem-focused coping strategies is higher in the population of alternative schools. Directions for further research on alternative schools are highlighted concerning coping as well as autonomy-supportive class climates.     

HUMOR AS AN INNOVATIVE METHOD FOR TEACHING SENSITIVE TOPICS

Guidelines for including geriatric content in six health care disciplines recommend training in topics such as fear of aging, death, dying, grieving, and suicide. The psychoanalytic theory of humor provides a basis for using humor to teach these sensitive topics. Humor used in clinical settings relieves anxiety, decreases discomfort, and provides a coping mechanism for both patients and health care providers. Humor used in educational settings increases comprehension, enhances retention, and improves faculty ratings. Suggestions are provided for incorporating humor into lesson plans and assignments. The use of humor contributes to learning and to improved health care for older people.     

Talking about death: Implementing peer discussion as a coping mechanism to overcome fears about dissection,death, and dying

Many studies have reported on the perceptions of medical students toward dissection. It is important to understand the feelings and symptoms experienced during dissection so that they can be adequately handled. Prior to dissection, first year students are given lectures on aspects of dissection, death and dying, and death rituals in various cultures. Two separate questionnaires, one given during the first week of dissection and another given one month into the program were then completed anonymously by dissection groups. The questions were designed to be open‐ended, thereby encouraging group discussion amongst students. The questionnaires were used to determine the perception of students to dissection and to discover if these perceptions change during the dissection program. The first questionnaire revealed that students do experience fears and anxiety prior to and at the beginning of dissection; however, most of these fears dissipated by the time of the second questionnaire. One month into dissection students cited talking to peers as their main coping mechanism and fewer students mentioned emotional detachment from their cadaver as a coping mechanism, as was the case in the first questionnaire. Dissection was perceived as a positive experience by our student cohort and most students cited the main advantage of dissection as the ability to visualize organs in three dimensions. The comprehensive answers received from the students indicated that thorough discussion of feelings amongst peers occurred, introducing students to an important coping mechanism at an early stage of their learning. Anat Sci Educ. © 2013 American Association of Anatomists.     

高职学生自我概念、应对方式与抑郁之关系的实证研究

通过采用田纳西自我概念量表、简易应对方式问卷和自评抑郁量表对重庆市某高职院校230名学生进行问卷调查,结果显示,自我概念在性别上有显著差异,抑郁与应对方式在性别上无显著差异;自我概念和抑郁在专业上有显著差异,应对方式在专业上没有显著差异;自我概念和抑郁之间差异显著,自我概念和应对方式之间差异显著,应对方式和抑郁之间差异显著。高职院校应该加强高职学生对各种社会生活事件正确应对方式的引导与训练,尤其是应该注重加强对在认知、情感、行为等方面有更多消极表现的高职学生进行教育与训练,使他们逐步形成积极的应对方式,以更好地适应现实环境,更好地发展自己、健康成长。     

Childhood sexual abuse, social support, and psychological outcomes: a loss framework

OBJECTIVE: The objectives of the study were: (a) to develop a scale to assess CSA-related loss among a college sample of CSA survivors (CSALM), (b) to examine the measure's convergent validity through associations among depression, alexithymia, coping, and social support, and (c) to test whether social support moderates the relation between multiple experiences of CSA and loss. METHOD: The study involved a survey methodology and included college-age women (n=116) reporting CSA experiences. RESULTS: Based on the Sexual Victimization Questionnaire (SVQ; [Finkelhor, D. (1979). Sexually victimized children. New York: The Free Press]), 90% of the sample reported CSA before age of 12, 12.3% (n=15) reported CSA before age 12 with an adult over 16, and 42.2% (n=49) reported CSA after age 12 with an adult. Exploratory Factor Analysis of the CSALM revealed a three-factor solution: (a) Loss of Optimism, (b) Loss of Self, and (c) Loss of Childhood. Convergent validity of several scales was evidenced through associations with depression, alexithymia, coping, and social support. Social support from family and friends was found to moderate the association between CSA experiences and loss dimensions. CONCLUSIONS: Findings provide preliminary psychometric support for the CSALM, a tool that will be useful in future investigations of loss among college-age CSA survivors. Findings also support using a loss framework to understand the current mental health of these survivors.     

A concurrent examination of protective factors associated with resilience and posttraumatic growth following childhood victimization

The present study concurrently examined protective factors associated with the adaptive outcomes of resilience and posttraumatic growth (PTG; defined as positive psychological change resulting from a life crisis or trauma), after accounting for relevant demographic factors and the impact of circumstances surrounding childhood victimization (i.e., age of first trauma, frequency of victimization, and perception of trauma severity). The protective factors examined in the present study included social support from friends and family, optimism, positive religious coping (i.e., looking to God for support and guidance; forgiveness), and negative religious coping (i.e., feeling abandoned by God; anger towards God). Participants included 161 college students from the US MidSouth, aged 18–24 (M_age = 19.97, SD = 1.86). All participants reported experiencing physical violence and/or sexual abuse during their childhood. Hierarchical multiple regression analyses indicated that after accounting for demographics and circumstances surrounding the childhood victimization, higher resilience was associated with greater family support, optimism, and positive religious coping, while higher posttraumatic growth was associated with greater optimism and positive religious coping. These findings underscore the protective role of optimism with respect to both resilience and posttraumatic growth. Additionally, results highlight the importance of examining cognitions related to religious coping rather than simply assessing broadband religiosity, as only positive religious coping was associated with adaptive outcomes. Findings suggest the importance of early intervention to bolster protective factors (i.e., family support, positive thinking, gratitude, and positive religious coping skills) among youth exposed to childhood physical and sexual victimization.     

Caring for the dying: advocacy or paternalism

Moral dilemmas in the care of a dying person ideally should be decided in the context of that person's own freely determined understanding of death. At the philosophical, the clinical, and the personal levels, the primal question of how to understand death must be addressed before decisions are made concerning much ethical problems as euthanasia. Philosophers and practitioners who fail to do this are guilty of an a priori paternalism toward the dying, on whom their conclusions will be imposed. Until we have determined, together with the person involved, the way in which that person wants to view his or her death, any prior ethical judgment not only is presumptuous but infringes on the most basic freedom, that of determining the meaning that one's own experience shall have. The role of advocacy is an alternative to the traditional paternalism toward the dying. The essay attempts to (a) develop the distinctions among paternalism, consumerism, and advocacy; (b) propose a concept of advocacy as the assistance to the dying in freely determining how to understand their dying and death; (c) describe three of the views of death (naturalistic, religious, and existentialist) that need to be understood by those who assist the dying in exercising their freedom of self-determination.     

Post-traumatic stress disorder, depression, and anxiety among Gaza Strip adolescents in the wake of the second Uprising (Intifada)

OBJECTIVE: Children and adolescents of the Gaza Strip have been subjected to continuous violence since the eruption of the second Intifada (Uprising). Little is known, however, about the psychological effects of this violence on children and adolescents of Gaza. Thus, the purpose of the present investigation was to evaluate and describe the psychological effects of exposure of war-like circumstances on this population. METHOD: Participants for this study were 229 Palestinian adolescents living in the Gaza Strip who were administered measures of post-traumatic stress disorder (PTSD), depression, anxiety, and coping. RESULTS: Of the 229 participants, 68.9% were classified as having developed PTSD, 40.0% reported moderate or severe levels of depression, 94.9% were classified as having severe anxiety levels, and 69.9% demonstrated undesirable coping responses. A canonical discriminant analysis revealed that adolescents diagnosed with PTSD tended to be those who reported the highest levels of depression, anxiety, and positive reappraisal coping, and the lowest levels of seeking guidance and support coping. CONCLUSIONS: These results indicate that a significant proportion of Palestinian adolescents living in the Gaza Strip are experiencing serious psychological distress.     

The effects of a short-term death training program on nursing home nursing staff

This study examines the effects on nursing home nurses of a two-day training program concerned with nurses and their response to the dying patient. Utilizing the Solomon four-group design, the study investigates whether exposure to information on death and dying (a) results in the acquisition of greater knowledge about death and dying, (b) is accompanied by a more positive attitude toward the elderly, and (c) is accompanied by a change in anxiety about death. Based on t tests and one-way analyses of covariance, the results point up the mixed nature of short-term training programs. It was found that there was a significant increase in the nurses' knowledge about death and dying, there was no change in their attitudes toward the elderly, and there was a significant increase among the nurses in the death anxiety experienced. This is not to suggest that training programs of this sort should not be conducted with nursing home staff. On the one hand such programs provide information useful for job performance. On the other hand they create some sensitization to death, which at the very least could give nurses greater insights into the concerns of the patients and perhaps stimulate empathetic responses.     

从伊丽莎白·库伯勒·罗斯死亡心理发展理论阐述《宠儿》女主人公摆脱痛苦的心路历程

本文旨在通过伊丽莎白·库伯勒·罗斯创立的死亡心理发展理论五个阶段:否认和隔绝、愤怒、讨价还价、沮丧、接受事实来阐述《宠儿》中女主人公塞丝在丹佛、保罗和黑人民众的帮助下走出痛苦,重获新生的心路历程。     

Multidimensional Perfectionism,Coping, and Depression: Differential Prediction of Depression Symptoms by Perfectionism Type

Perfectionism has consistently been implicated as a significant contributor to negative outcomes, including depression, in college student populations. This study examined the relationship between multidimensional perfectionism, coping, and depression in a sample of 405 undergraduate students. Maladaptive perfectionists, adaptive perfectionists, and nonperfectionist college students differed significantly on levels of depression and exhibited different patterns of coping. Avoidant coping mediated the relationship between both adaptive and maladaptive perfectionism and depression.     

Coping, Stress, and the Psychological Symptoms of Children of Divorce: A Cross-sectional and Longitudinal Study

The authors conducted a cross-sectional and prospective longitudinal study of stress, coping, and psychological symptoms in children of divorce. The sample consisted of 258 children (mean age = 10.1; SD = 1.2), of whom 196 were successfully followed 5.5 months later. A 4-dimensional model of coping was found using confirmatory factor analysis, with the factors being active coping, avoidance, distraction, and support. In the cross-sectional model avoidance coping partially mediated the relations between negative events and symptoms while active coping moderated the relations between negative events and conduct problems. In the longitudinal model significant negative paths were found from active coping and distraction Time 1 to internalizing symptoms Time 2, while Time 1 support coping had a positive path coefficient to Time 2 depression. Positive paths were found between negative events at Time 1 and anxiety at Time 2, and between all symptoms at Time 1 and negative events at Time 2.     

在老年服务照料中“精神赡养”应引起社会的高度关注

从数例空巢老人在孤独、抑郁中非正常死亡报道中引出新论：在老年服务照料中＂精神赡养＂应引起社会的高度关注。并从经济体制改革、家庭结构分解;城市化进程加快,家园变迁;多元价值对传统价值观冲击等方面分析其原因,最后提出几点应对之策。     

The effects of a course on death and grief on nurses' attitudes toward dying patients and death

The purpose of this study was to measure the effects of a course on death and grief on the attitudes toward death and toward dying patients of nurses who work in high-risk death areas of hospitals. This quasi-experimental design used four groups of subjects. One group experienced the treatment. Another group served as a waiting-list control group and then experienced the treatment. Two groups were control groups. The treatment consisted of attendance at a 6-week continuing education course entitled "Coping with Death and Dying in High-risk Areas of Hospitals." The Death Anxiety Semantic Differential, Parts I and II, was used as the dependent variable. The results indicate that the small-group counseling and education experience did have an impact on attitudes toward death and dying patients of nurses who attended. The discussion of the findings and recommendations for further study are presented.     

Social class and violent child death: An analysis of fatal nonaccidental injury,murder, and fatal child neglect

A total population study to analyse socio-economic status (SES) concomitants of violent and nonaccidental deaths involving children in Queensland, Australia is reported. Cases were traced from coronial files of the Institute of Forensic Pathology, Queensland. All children dying of nonaccidental injuries, neglect, and murder were included. Children were excluded where death was part of the neonaticide syndrome of pregnancy-parturition-concealment. Socioeconomic status scores were assigned to each case using the Congalton four point scale of occupational status. Of the 43 children in the study, 58% were girls. The age of greatest risk of death was in the 1st year of life. A second modal age at 3 years was evident for children who were murdered. Differences in age distribution and socioeconomic status were evident between children who died as a result of nonaccidental injury (N.A.I.), and those who were frankly murdered. All of the children who died as a result of N.A.I. were from lower socioeconomic groups. However, the socioeconomic status distribution for all violent deaths (N.A.I., murder and neglect) is not unlike the socioeconomic status distribution for the general population.