The Nature and Meaning of near death experince for Patients and Critical Care Nurses

团购合买资源类别：文库，文档格式：PDF，文档页数：29，文件大小：147.5KB

P1: GRA Journal of Near-Death Studies ph167-jond-455246 November 22, 2002 9:37 Style file version September 27, 2002 The Nature and Meaning of the Near-Death Experience for Patients and Critical Care Nurses Linda L. Morris, Ph.D., RN, C Nursing Education Consultants, Darien, IL Kathleen Knafl, Ph.D., FAAN Yale University, New Haven, CT ABSTRACT: This study was designed to develop a conceptual framework for the near-death experience (NDE), reflecting its nature and meaning for the patient and the critical care nurse. The study used naturalistic inquiry to examine the question: What is the nature and meaning of an NDE and how has it influenced the individual’s view of the self, the future, and feelings and beliefs about life and death? The NDE Scale (Greyson, 1983) was used with patients and semi-structured interview guides were used with both nurses and patients to explore the NDE from a comprehensive perspective. An NDE was defined as the report of “unusual” recollections associated with a period of unconsciousness during either serious illness or injury, or resuscitation from a cardiac or respiratory arrest. The sample included 12 patients who experienced an NDE and 19 nurses who cared for patients who experienced NDEs. This study highlighted the emotional aspects of the NDE. Patients described how the NDE transformed their lives and nurses reported how their experiences with patients changed them personally and professionally. KEY WORDS: near-death experience (NDE); qualitative research; aftereffects; unconsciousness; spirituality; spiritual distress. Linda L. Morris, Ph.D., RN, C, is the President of Nursing Education Consultants of Darien, IL. Kathleen Knafl, Ph.D., FAAN, is a professor in the doctoral program at the Yale University School of Nursing, where she is pursuing a program of research related to family response to childhood chronic illness. This paper is based on a presentation at the International Association for Near-Death Studies Annual Conference, Seattle Pacific University, July 27, 2001. Reprint requests should be addressed to Dr. Morris at 8305 Highpoint Circle, Suite A, Darien, IL 60561. Journal of Near-Death Studies, 21(3), Spring 2003 °C 2003 Human Sciences Press, Inc. 139

140 JOURNAL OF NEAR-DEATH STUDIES Despite the abundance of writings in the lay press on the near-death experience (NDE)and related phenomena, it is a poorly understood event in the intensive care unit. One may wonder why there is such interest in a topic that is so difficult to explain. In the literature the definition of what constitutes an NdE is unclear. Patients may be con- sidered "near-death"as a result of several factors, such as cardiac or respiratory arrest, and severe shock or trauma. However, a common attribute of such states is a period of unconsciousness that is not the result of anesthesia. To the observer, these patients do not (or cannot) respond, but it is during thi od of unconsciousness when some sur- vivors have reported unusual recollections, some of which have been verified by others Many people claim that the NDE is"proof"of an existence beyond death because some survivors claim to have experienced "the here- after. Other researchers claim that the nde is merely the sensory manifestation of a dying brain(Blackmore, 1988, 1991)or produced by erratic electrical misfiring in the brain( Carr, 1982)or chemical im- balances (Jansen, 1990). Still others lie in the middle, convinced that here is something compelling in the stories of those who have expe- rienced another dimension, but unable fully to understand it. despite he wide range of skepticism and sometimes sensationalism, those who have had an NDE are nonetheless, often changed by it. Their expe- riences also affect people who hear the stories of those who have had NDES Although exact numbers cannot be known, many survivors of car- iac arrest have experienced an NDE; however, critical care personnel have inadequate knowledge to manage these patients. And it is clear that these patients need a supportive person to listen to their stories and understand their concerns(garrison, 1989; James, 1994). It is es timated that 1.000 sudden cardiac deaths occur in the united states every day(Emergency Cardiac Care Committee and Subcommittees 1992). Featherston defined sudden cardiac death as"an unexpected witnessed death of an apparently well person resulting from cardiac dysfunction and occurring within 1 hour of the onset of new symp- toms"(1988, p. 242). Results of successful resuscitation in the hospital have not been systematically reported due to several factors; however, several informal sources list survival rates at 53 percent (C Mclane, personal communication, February, 1993), 60 percent(D Knudsen, per sonal communication, May, 2000), or 67 percent (Morris and Fachet 1992). Considering that these figures do not take into account the nu merous factors involved, such as cause or lengths of survival, these

P1: GRA Journal of Near-Death Studies ph167-jond-455246 November 22, 2002 9:37 Style file version September 27, 2002 140 JOURNAL OF NEAR-DEATH STUDIES Despite the abundance of writings in the lay press on the near-death experience (NDE) and related phenomena, it is a poorly understood event in the intensive care unit. One may wonder why there is such interest in a topic that is so difficult to explain. In the literature, the definition of what constitutes an NDE is unclear. Patients may be considered “near-death” as a result of several factors, such as cardiac or respiratory arrest, and severe shock or trauma. However, a common attribute of such states is a period of unconsciousness that is not the result of anesthesia. To the observer, these patients do not (or cannot) respond, but it is during this period of unconsciousness when some survivors have reported unusual recollections, some of which have been verified by others. Many people claim that the NDE is “proof” of an existence beyond death because some survivors claim to have experienced “the hereafter.” Other researchers claim that the NDE is merely the sensory manifestation of a dying brain (Blackmore, 1988, 1991) or produced by erratic electrical misfiring in the brain (Carr, 1982) or chemical imbalances (Jansen, 1990). Still others lie in the middle, convinced that there is something compelling in the stories of those who have experienced another dimension, but unable fully to understand it. Despite the wide range of skepticism and sometimes sensationalism, those who have had an NDE are, nonetheless, often changed by it. Their experiences also affect people who hear the stories of those who have had NDEs. Although exact numbers cannot be known, many survivors of cardiac arrest have experienced an NDE; however, critical care personnel have inadequate knowledge to manage these patients. And it is clear that these patients need a supportive person to listen to their stories and understand their concerns (Garrison, 1989; James, 1994). It is estimated that 1,000 sudden cardiac deaths occur in the United States every day (Emergency Cardiac Care Committee and Subcommittees, 1992). Featherston defined sudden cardiac death as “an unexpected witnessed death of an apparently well person resulting from cardiac dysfunction and occurring within 1 hour of the onset of new symptoms” (1988, p. 242). Results of successful resuscitation in the hospital have not been systematically reported due to several factors; however, several informal sources list survival rates at 53 percent (C. McLane, personal communication, February, 1993), 60 percent (D. Knudsen, personal communication, May, 2000), or 67 percent (Morris and Fachet, 1992). Considering that these figures do not take into account the numerous factors involved, such as cause or lengths of survival, these

LINDA L. MORRIS AND KATHLEEN KNAFL numbers are quite similar. If these figures are representative, then a large number of persons each year are surviving clinical death. Literature review Survivors of NDEs have significant psychosocial issues to resolve af- ter the acute event. One of us (LL M )conducted a preliminary in- tegrative review of the literature on survivors of cardiac arrest and myocardial infarction, concluding that the major issues were linked to resolving the meaning and addressing the emotional sequelae. In other words, survivors of cardiac arrest and myocardial infarction, a large group of patients who experience NDEs, need the support of caregivers ho are well-informed regarding their emotional needs The early literature on the nde, through the early 1980s, described features associated with the experience itself, such as a light a tunnel, and an out-of-body experience(OBE). The literature of the later 1980s reported on the aftereffects of the e experlence he integrative review of the literature included 13 studies that discussed the features associated with an NDe, only two of which( Greyson and Stevenson, 1980; Morse Castillo, Venecia, Milstein, and Tyler, 1986)described examination of medical records as a method to confirm inclusion criteria. eight of the studies used convenience sampling methods, two studies described a purposive sampling approach, and one study(Atwater, 1988)described a random selection of cases from the archives of the international as sociation for Near- Death studies The remainder of the studies did not describe the sampling method Two studies included interview of a secondary source such as a fam ly member or physician to support the primary source. Twelve of the studies used a questionnaire but reliability data were absent in all but two(Greyson, 1983; Ring, 1980) Gender and ethnicity seemed to be factors in reporting NDEs. Stu- rt Twemlow and Glen Gabbard (1984-85)reported that 65 percent of their sample of 339 near-death experiencers were female, and that male respondents tended to have NDEs much more commonly as a re- sult of accident or physical injury than did females, who more often had an NDe as a result of illness. with two exceptions, most authors did not report the ethnic composition of samples. Bruce Greyson and lan Stevenson(1980)reported that all their subjects were Caucasian; and Kenneth Ring(1980)reported that 95 percent of his sample of 102 sub jects were Caucasian and 5 percent were African-American

P1: GRA Journal of Near-Death Studies ph167-jond-455246 November 22, 2002 9:37 Style file version September 27, 2002 LINDA L. MORRIS AND KATHLEEN KNAFL 141 numbers are quite similar. If these figures are representative, then a large number of persons each year are surviving clinical death. Literature Review Survivors of NDEs have significant psychosocial issues to resolve after the acute event. One of us (L.L.M.) conducted a preliminary integrative review of the literature on survivors of cardiac arrest and myocardial infarction, concluding that the major issues were linked to resolving the meaning and addressing the emotional sequelae. In other words, survivors of cardiac arrest and myocardial infarction, a large group of patients who experience NDEs, need the support of caregivers who are well-informed regarding their emotional needs. The early literature on the NDE, through the early 1980s, described features associated with the experience itself, such as a light, a tunnel, and an out-of-body experience (OBE). The literature of the later 1980s reported on the aftereffects of the experience. The integrative review of the literature included 13 studies that discussed the features associated with an NDE, only two of which (Greyson and Stevenson, 1980; Morse, Castillo, Venecia, Milstein, and Tyler, 1986) described examination of medical records as a method to confirm inclusion criteria. Eight of the studies used convenience sampling methods, two studies described a purposive sampling approach, and one study (Atwater, 1988) described a random selection of cases from the archives of the International Association for Near-Death Studies. The remainder of the studies did not describe the sampling method. Two studies included interview of a secondary source such as a family member or physician to support the primary source. Twelve of the studies used a questionnaire, but reliability data were absent in all but two (Greyson, 1983; Ring, 1980). Gender and ethnicity seemed to be factors in reporting NDEs. Stuart Twemlow and Glen Gabbard (1984–85) reported that 65 percent of their sample of 339 near-death experiencers were female, and that male respondents tended to have NDEs much more commonly as a result of accident or physical injury than did females, who more often had an NDE as a result of illness. With two exceptions, most authors did not report the ethnic composition of samples. Bruce Greyson and Ian Stevenson (1980) reported that all their subjects were Caucasian; and Kenneth Ring (1980) reported that 95 percent of his sample of 102 subjects were Caucasian and 5 percent were African-American

JOURNAL OF NEAR-DEATH STUDIES NDE Features The features of the NDe have been a topic of inquiry since 1975, when the popular book Life After Life(Moody, 1975) was published In this work, Raymond Moody first described the NDe after inter- viewing 150 persons resuscitated from cardiac arrest or who other- wise came close to death as a result of severe accident or injury. h found a consistent pattern of features, which later came to be known as the "core experience"(Ring, 1984), including the following features There is an initial sensation of peace and serenity, while seeing the self as separate from the physical body(an out-of-body experience, of OBE). Upon leaving the body, all pain is gone. The disembodied self enters a tunnel or darkness, traveling at great speed and encountering a light at the end of the tunnel, which seems to radiate love. others come to greet and welcome the person to his or her new environment While in the light, the individual experiences a life review or panoramic memory, which is observed objectively, yet experienced with the orig. inal emotions. The person then reaches a border or limit. Some are given the choice to return, whereas for others the decision is made for them. Upon return to the body, the pain, if previously present, Numerous studies have been conducted since this landmark work and most have had consistent findings. Three studies also provided a measurement tool to measure the depth of NDEs, based on the num- ber of characteristics reported(Greyson, 1983, 1985; Ring, 1980). The most notable exception to the consistency in the literature was a study of experiencers in India, who were less likely to have OBEs and had a tendency to have residual marks on the body after the experience (Pasricha and Stevenson, 1986). Other notable exceptions were the re- ports of frightening or"hell-like"NDEs(Bush, 1994; Greyson and Bush, 1992; Rawlings, 1978, 1993; Ritchie, 1978). These experiences are not well reported as the core experience Limitations in the Studies of features There were several limitations that were noted in the studies that re- ported the features of the NDE. First, the method of subject recruitment was often self-selection. In many cases, it was the subjects response to a notice in a magazine that qualified them for the study whether or not they were truly "near death"at the time of the incident. Being near death is very subjective, especially in our common language. To say"I

P1: GRA Journal of Near-Death Studies ph167-jond-455246 November 22, 2002 9:37 Style file version September 27, 2002 142 JOURNAL OF NEAR-DEATH STUDIES NDE Features The features of the NDE have been a topic of inquiry since 1975, when the popular book Life After Life (Moody, 1975) was published. In this work, Raymond Moody first described the NDE after interviewing 150 persons resuscitated from cardiac arrest or who otherwise came close to death as a result of severe accident or injury. He found a consistent pattern of features, which later came to be known as the “core experience” (Ring, 1984), including the following features. There is an initial sensation of peace and serenity, while seeing the self as separate from the physical body (an out-of-body experience, or OBE). Upon leaving the body, all pain is gone. The disembodied self enters a tunnel or darkness, traveling at great speed and encountering a light at the end of the tunnel, which seems to radiate love. Others come to greet and welcome the person to his or her new environment. While in the light, the individual experiences a life review or panoramic memory, which is observed objectively, yet experienced with the original emotions. The person then reaches a border or limit. Some are given the choice to return, whereas for others the decision is made for them. Upon return to the body, the pain, if previously present, returns. Numerous studies have been conducted since this landmark work, and most have had consistent findings. Three studies also provided a measurement tool to measure the depth of NDEs, based on the number of characteristics reported (Greyson, 1983, 1985; Ring, 1980). The most notable exception to the consistency in the literature was a study of experiencers in India, who were less likely to have OBEs and had a tendency to have residual marks on the body after the experience (Pasricha and Stevenson, 1986). Other notable exceptions were the reports of frightening or “hell-like” NDEs (Bush, 1994; Greyson and Bush, 1992; Rawlings, 1978, 1993; Ritchie, 1978). These experiences are not as well reported as the core experience. Limitations in the Studies of Features There were several limitations that were noted in the studies that reported the features of the NDE. First, the method of subject recruitment was often self-selection. In many cases, it was the subject’s response to a notice in a magazine that qualified them for the study, whether or not they were truly “near death” at the time of the incident. Being near death is very subjective, especially in our common language. To say “I

LINDA L. MORRIS AND KATHLEEN KNAFL almost died"can mean anything from acute embarrassment to being in a"near-miss "accident to being hospitalized in intensive care as result of trauma or disease. In most cases the state of near -death was not described. nor was it corroborated. Another limitation of these studies was the skewed sampling of gen- der and ethnicity. Participants tended to be Caucasian and women, and there seemed to be no effort to obtain a representative sample of men and women of varying ethnic backgrounds In addition, there was no description of the instruments, which were presumably interview guides. In qualitative research, the instruments of data collection provide the basis for understanding the nature of the interview. Without a description of the instruments, it was impossible to determine whether the interview protocols were appropriate for the Studies of Meaning and Aftereffects There were eight studies of meaning and aftereffects included in the integrative review of the literature. All of them used an interview or questionnaire method of obtaining data. All of the studies described a positive outcome of the NDE. Three studies described a decreased fear of death(Bauer, 1985; Grey, 1985; Noyes, 1980). Half of the stud ies found that the subjects had a calmer and more accepting attitude toward others and life in general. Other studies reported a strength ened belief in life after death, a renewed sense of purpose in life, or a re-evaluation of priorities( Bauer, 1985; Ring, 1984; Ring and valarino 1988). Taken together, these studies of the meaning and aftereffects of the nde pointed toward a process of changed values and beliefs as a result of the experience. There was less concern with material things and more concern with relationships following the NDE. another term that could describe this outcome was increased spirituality, which is defined as pertaining to the"spirit or soul as distinguished from the body or material matters"(Guralnik, 1980, p. 1373). This view coin- cided with an interesting concept analysis of spirituality(Haase, Britt, Coward, Leidy, and Penn, 1992), which found that the three outcomes of spirituality were a purpose and meaning in life guidance of values and behavior, and self-transcendence, which reaches out beyond reality and allows the individual to rise above personal and material concerns. This description of spirituality fits well with the studies of meaning and aftereffects of NDEs. The present study was built on these studies of meaning and aftereffects

P1: GRA Journal of Near-Death Studies ph167-jond-455246 November 22, 2002 9:37 Style file version September 27, 2002 LINDA L. MORRIS AND KATHLEEN KNAFL 143 almost died” can mean anything from acute embarrassment to being in a “near-miss” accident to being hospitalized in intensive care as a result of trauma or disease. In most cases, the state of near-death was not described, nor was it corroborated. Another limitation of these studies was the skewed sampling of gender and ethnicity. Participants tended to be Caucasian and women, and there seemed to be no effort to obtain a representative sample of men and women of varying ethnic backgrounds. In addition, there was no description of the instruments, which were presumably interview guides. In qualitative research, the instruments of data collection provide the basis for understanding the nature of the interview. Without a description of the instruments, it was impossible to determine whether the interview protocols were appropriate for the research questions. Studies of Meaning and Aftereffects There were eight studies of meaning and aftereffects included in the integrative review of the literature. All of them used an interview or questionnaire method of obtaining data. All of the studies described a positive outcome of the NDE. Three studies described a decreased fear of death (Bauer, 1985; Grey, 1985; Noyes, 1980). Half of the studies found that the subjects had a calmer and more accepting attitude toward others and life in general. Other studies reported a strengthened belief in life after death, a renewed sense of purpose in life, or a re-evaluation of priorities (Bauer, 1985; Ring, 1984; Ring and Valarino, 1988). Taken together, these studies of the meaning and aftereffects of the NDE pointed toward a process of changed values and beliefs as a result of the experience. There was less concern with material things and more concern with relationships following the NDE. Another term that could describe this outcome was increased spirituality, which is defined as pertaining to the “spirit or soul as distinguished from the body or material matters” (Guralnik, 1980, p. 1373). This view coincided with an interesting concept analysis of spirituality (Haase, Britt, Coward, Leidy, and Penn, 1992), which found that the three outcomes of spirituality were a purpose and meaning in life, guidance of values and behavior, and self-transcendence, which reaches out beyond reality and allows the individual to rise above personal and material concerns. This description of spirituality fits well with the studies of meaning and aftereffects of NDEs. The present study was built on these studies of meaning and aftereffects

JOURNAL OF NEAR-DEATH STUDIES Specific Aims of This Study The NDE is a very personal and individual experience that has great meaning to those who experience it. Critical care practitioners care for people at significant moments of crisis in their lives. They hear stories from their patients who have experienced NDEs. NDEs hold great meaning for the patients as well as the practitioners who care for these patients. Although the subjective experiences of the patients and the nurses regarding the nde are described in this study it was the degree to which people were changed and the way in which they were changed that is the major focus. For this study, a near-death event was the condition that caused the patient to be near to death: for example, cardiac or respiratory arrest severe shock, or trauma. The term NDE referred to the report of fea- tures associated with a period of unconsciousness due to a near-death This research was designed to develop a conceptual framework for the near-death experience reflecting its meaning and significance for the patient and the nurse The study used naturalistic inquiry to ex- amine the question: What is the nature and meaning of a near-death experience and how has it influenced the individual s view of the self, the future, and feelings and beliefs about life and death? Specific aims that guided the collection of data included: (1)describing the experience of the patient surrounding the period of unconsciousness; (2)describing the nature and meaning that this experience holds for the patient, in terms of the individual's view of the self, the future, and relationships with others; (3)describing the experience of critical care nurses in car- ing for patients before, during, and after the period of unconsciousness which was not linked to anesthesia; (4)describing the nature and mean- ing that this experience holds for the nurse, in terms of the nurse s view of the self, the future, and the caregiver role; and (5)comparing the re- sponses of nurses and patients with regard to perception, meaning, and significance of these experiences. One goal of this study was to address some of the shortcomings of previous research on the subject. Subjects were sought purposefully, rather than relying on self-selection as in many of the previous studies Second, the state of near-death was specifically defined and subjects who met the criteria were included. Third. the state of near -death was verified in most instances. Fourth, there was an equal sampling of men and women, and a sample of ethnic diversity was purposively sought Finally, the instruments used were clearly described

P1: GRA Journal of Near-Death Studies ph167-jond-455246 November 22, 2002 9:37 Style file version September 27, 2002 144 JOURNAL OF NEAR-DEATH STUDIES Specific Aims of This Study The NDE is a very personal and individual experience that has great meaning to those who experience it. Critical care practitioners care for people at significant moments of crisis in their lives. They hear stories from their patients who have experienced NDEs. NDEs hold great meaning for the patients as well as the practitioners who care for these patients. Although the subjective experiences of the patients and the nurses regarding the NDE are described in this study, it was the degree to which people were changed and the way in which they were changed that is the major focus. For this study, a near-death event was the condition that caused the patient to be near to death: for example, cardiac or respiratory arrest, severe shock, or trauma. The term NDE referred to the report of features associated with a period of unconsciousness due to a near-death event. This research was designed to develop a conceptual framework for the near-death experience reflecting its meaning and significance for the patient and the nurse. The study used naturalistic inquiry to examine the question: What is the nature and meaning of a near-death experience and how has it influenced the individual’s view of the self, the future, and feelings and beliefs about life and death? Specific aims that guided the collection of data included: (1) describing the experience of the patient surrounding the period of unconsciousness; (2) describing the nature and meaning that this experience holds for the patient, in terms of the individual’s view of the self, the future, and relationships with others; (3) describing the experience of critical care nurses in caring for patients before, during, and after the period of unconsciousness, which was not linked to anesthesia; (4) describing the nature and meaning that this experience holds for the nurse, in terms of the nurse’s view of the self, the future, and the caregiver role; and (5) comparing the responses of nurses and patients with regard to perception, meaning, and significance of these experiences. One goal of this study was to address some of the shortcomings of previous research on the subject. Subjects were sought purposefully, rather than relying on self-selection as in many of the previous studies. Second, the state of near-death was specifically defined and subjects who met the criteria were included. Third, the state of near-death was verified in most instances. Fourth, there was an equal sampling of men and women, and a sample of ethnic diversity was purposively sought. Finally, the instruments used were clearly described

LINDA L. MORRIS AND KATHLEEN KNAFL Study Design and Methods This study used the qualitative approach of naturalistic inquiry (Lincoln and Guba, 1985), which is the process of exploring naturall occurring phenomena in order to gain understanding. For the purpose of this study, an NDe was defined as the report of"unusual recollec- tions associated with a period of unconsciousness during either serious Iness or injury, or during resuscitation from a cardiac or respiratory arrest. In order to enhance completeness of the topic and validity of the findings, triangulation of methods was used. This included the use of intensive interviewing in conjunction with a structured instrument, the Near-Death Experience Scale( Greyson, 1983), in order to elicit the perspectives of both patients and nurses Credibility of the findings was enhanced by the use of multiple sites, multiple subjects, and multiple modes of data collection Participant Participants were recruited from eight hospitals within the Chicago metropolitan area. Multiple sites were targeted to assure a diverse sample with regard to demographic characteristics, including ethnic- ity, gender, and socioeconomic status. The patient sample included 12 adults, age 18 and older, who had either survived and had recall of a cardiac or respiratory arrest, or who had survived a serious ill- ness with a period of unconsciousness that was not linked to anesthe- sia. The nurse sample included 19 critical care nurses who had cared for at least one patient who had experienced an NDE. Thirty-five au- diotaped interviews were conducted and transcribed verbatim. An ad- ditional group interview consisted of nurses' discussion at a contin- uing education program for nurses on NDEs that one of us (LL M) Patients. The patient sample included six men and six women. One subject who had no recall of the experience was used for compara- tive purposes. Patients were recruited from eight hospitals within the Chicago metropolitan area. The patients ranged in age from 24 to 73 years, with a mean of 48. 1 years. The age of the men ranged from 32 to 73 years, and the age of the women ranged from 24 to 66 years ix patients were married, four were divorced, and two were single Ethnic background included eight Caucasian subjects, two African- American, one Asian, and one Syrian. Religious affiliations included

P1: GRA Journal of Near-Death Studies ph167-jond-455246 November 22, 2002 9:37 Style file version September 27, 2002 LINDA L. MORRIS AND KATHLEEN KNAFL 145 Study Design and Methods This study used the qualitative approach of naturalistic inquiry (Lincoln and Guba, 1985), which is the process of exploring naturally occurring phenomena in order to gain understanding. For the purpose of this study, an NDE was defined as the report of “unusual recollections associated with a period of unconsciousness during either serious illness or injury, or during resuscitation from a cardiac or respiratory arrest.” In order to enhance completeness of the topic and validity of the findings, triangulation of methods was used. This included the use of intensive interviewing in conjunction with a structured instrument, the Near-Death Experience Scale (Greyson, 1983), in order to elicit the perspectives of both patients and nurses. Credibility of the findings was enhanced by the use of multiple sites, multiple subjects, and multiple modes of data collection. Participants Participants were recruited from eight hospitals within the Chicago metropolitan area. Multiple sites were targeted to assure a diverse sample with regard to demographic characteristics, including ethnicity, gender, and socioeconomic status. The patient sample included 12 adults, age 18 and older, who had either survived and had recall of a cardiac or respiratory arrest, or who had survived a serious illness with a period of unconsciousness that was not linked to anesthesia. The nurse sample included 19 critical care nurses who had cared for at least one patient who had experienced an NDE. Thirty-five audiotaped interviews were conducted and transcribed verbatim. An additional group interview consisted of nurses’ discussion at a continuing education program for nurses on NDEs that one of us (L.L.M.) led. Patients. The patient sample included six men and six women. One subject who had no recall of the experience was used for comparative purposes. Patients were recruited from eight hospitals within the Chicago metropolitan area. The patients ranged in age from 24 to 73 years, with a mean of 48.1 years. The age of the men ranged from 32 to 73 years, and the age of the women ranged from 24 to 66 years. Six patients were married, four were divorced, and two were single. Ethnic background included eight Caucasian subjects, two AfricanAmerican, one Asian, and one Syrian. Religious affiliations included

146 JOURNAL OF NEAR-DEATH STUDIES eight Protestants, two Christian, one Jewish, one Catholic, and one pa tient who did not identify a religious affiliation The events that precipitated the NDE included a combination of ute and serious health problems, as well as traumatic events. The serious health problems included septic shock, hypovolemic shock, dia- betic coma, and hepatic coma. The acute events included cardiac ar rest, ventricular fibrillation, respiratory arrest, respiratory distress, and ruptured ectopic pregnancy. The traumatic events included a bicy cle accident in which one patient was hit by a truck, and a stab wound to the heart cluded 19 critical care nurses. All of th arses indicated that they had cared for patients who had an NDE Their age ranged from 31 to 53, with a mean of 43.6 years. Religious affiliations included 9 Catholics. 8 Protestants and 2 who did not affili ate with any particular religion. Years of experience in nursing ranged from 3 to 26, with a mean of 16. 4 years ure Six patients were interviewed within one month of their NDe and six patients were interviewed within two years of the experience. In order to examine the process of recovery from the event, three of the patients from the first group were interviewed a second time four to six months after the event. For comparative purposes, one of us (LL M) also used theoretical sampling for one interview in selecting a subject who experienced a near-death event but had no memory of the of unconsciousness All 12 patients were asked to sign an informed consent agreement and were assured of the voluntary nature of the study. arrangements were then made for a taped interview and completion of the NdE Scale In seven patients, the medical records were reviewed in order to pro- vide background information so that potential confounding variables (such as drugs, length of arrest, and type of near-death event)could be identified. The records of the remaining patients were unavailable for review, most often because the patient was cared for at a nonparticipat- ng hospital Patients and nurses were interviewed at a time and place of their choice. One of us (LL M)conducted all interviews. The interview guides were used in a flexible manner, with the primary objective of encouraging all subjects to recount their experience in detail

P1: GRA Journal of Near-Death Studies ph167-jond-455246 November 22, 2002 9:37 Style file version September 27, 2002 146 JOURNAL OF NEAR-DEATH STUDIES eight Protestants, two Christian, one Jewish, one Catholic, and one patient who did not identify a religious affiliation. The events that precipitated the NDE included a combination of acute and serious health problems, as well as traumatic events. The serious health problems included septic shock, hypovolemic shock, diabetic coma, and hepatic coma. The acute events included cardiac arrest, ventricular fibrillation, respiratory arrest, respiratory distress, and ruptured ectopic pregnancy. The traumatic events included a bicycle accident in which one patient was hit by a truck, and a stab wound to the heart. Nurses. The nurse sample included 19 critical care nurses. All of the nurses indicated that they had cared for patients who had an NDE. Their age ranged from 31 to 53, with a mean of 43.6 years. Religious affiliations included 9 Catholics, 8 Protestants, and 2 who did not affiliate with any particular religion. Years of experience in nursing ranged from 3 to 26, with a mean of 16.4 years. Procedure Six patients were interviewed within one month of their NDE and six patients were interviewed within two years of the experience. In order to examine the process of recovery from the event, three of the patients from the first group were interviewed a second time, four to six months after the event. For comparative purposes, one of us (L.L.M.) also used theoretical sampling for one interview in selecting a subject who experienced a near-death event but had no memory of the period of unconsciousness. All 12 patients were asked to sign an informed consent agreement and were assured of the voluntary nature of the study. Arrangements were then made for a taped interview and completion of the NDE Scale. In seven patients, the medical records were reviewed in order to provide background information so that potential confounding variables (such as drugs, length of arrest, and type of near-death event) could be identified. The records of the remaining patients were unavailable for review, most often because the patient was cared for at a nonparticipating hospital. Patients and nurses were interviewed at a time and place of their choice. One of us (L.L.M.) conducted all interviews. The interview guides were used in a flexible manner, with the primary objective of encouraging all subjects to recount their experience in detail

LINDA L. MORRIS AND KATHLEEN KNAFL Separate interview guides were developed and pilot tested for pa- tients and for nurses. The patient interview guides were developed to explore the period of unconsciousness as well as the meaning and significance of the NDE. A follow-up interview guide was developed to determine whether participants'feelings and beliefs changed over time The nurse interview guide explored a variety of issues related to life and death and patients' thoughts and feelings surrounding resuscita- tion questions on the interview guides reflected the aims of the study the literature, and our clinical experience. For this study, the purpose in utilizing the Near-Death Experience Scale( Greyson, 1983)was to provide a foundation for the depth of the NDE itself. The NDE Scale was based on previous work(Noyes and Slymen, 1978-79; Ring, 1980)and was developed in order to provide a specific measure of depth of and NDE. The final NDE Scale of 16 items was derived from responses of 67 individuals describing 74 NDEs. Four item clusters were identified: cognitive, affective, paranormal, and tran- cendental. Crohnbach's alpha was 88 for the entire scale and ranged from 66 to 86 for each cluster. Test-retest reliabilities after four to six months were. 92 for the entire scale and ranged from 79 to 95 for each cluster Data Management and analysis Each of the 35 interviews was transcribed verbatim, resulting in more than 900 pages of transcripts. Each line of text was analyzed for content and meaning and assigned an appropriate descriptive code, based on the aims of this research Codes were then further reduced nd grouped, first into major themes, and then into major category domains. two categories of themes were short-term meaning and long term meaning. In order to verify consistency and reliability of coding, three tran scripts were checked with a doctorally prepared colleague with exper tise in qualitative technique. Coding two transcripts each, the initial reliability rate of the interviewer(LL M ) and the expert was 76 per cent. In order to ensure completeness and reliability of coding, we re- ewed all of the transcripts and recoded each one. This was a helpful xercise. in that we were able to correct several instances of codes that were too specific, and several additional codes were added. The expert was asked to code a third transcript, which was compared to that of the interviewer: The final percent agreement was 96 percent

P1: GRA Journal of Near-Death Studies ph167-jond-455246 November 22, 2002 9:37 Style file version September 27, 2002 LINDA L. MORRIS AND KATHLEEN KNAFL 147 Separate interview guides were developed and pilot tested for patients and for nurses. The patient interview guides were developed to explore the period of unconsciousness as well as the meaning and significance of the NDE. A follow-up interview guide was developed to determine whether participants’ feelings and beliefs changed over time. The nurse interview guide explored a variety of issues related to life and death and patients’ thoughts and feelings surrounding resuscitation. Questions on the interview guides reflected the aims of the study, the literature, and our clinical experience. For this study, the purpose in utilizing the Near-Death Experience Scale (Greyson, 1983) was to provide a foundation for the depth of the NDE itself. The NDE Scale was based on previous work (Noyes and Slymen, 1978–79; Ring, 1980) and was developed in order to provide a specific measure of depth of and NDE. The final NDE Scale of 16 items was derived from responses of 67 individuals describing 74 NDEs. Four item clusters were identified: cognitive, affective, paranormal, and transcendental. Crohnbach’s alpha was .88 for the entire scale and ranged from .66 to .86 for each cluster. Test-retest reliabilities after four to six months were .92 for the entire scale and ranged from .79 to .95 for each cluster. Data Management and Analysis Each of the 35 interviews was transcribed verbatim, resulting in more than 900 pages of transcripts. Each line of text was analyzed for content and meaning and assigned an appropriate descriptive code, based on the aims of this research. Codes were then further reduced and grouped, first into major themes, and then into major category domains. Two categories of themes were short-term meaning and longterm meaning. In order to verify consistency and reliability of coding, three transcripts were checked with a doctorally prepared colleague with expertise in qualitative technique. Coding two transcripts each, the initial reliability rate of the interviewer (L.L.M.) and the expert was 76 percent. In order to ensure completeness and reliability of coding, we reviewed all of the transcripts and recoded each one. This was a helpful exercise, in that we were able to correct several instances of codes that were too specific, and several additional codes were added. The expert was asked to code a third transcript, which was compared to that of the interviewer. The final percent agreement was 96 percent

JOURNAL OF NEAR-DEATH STUDIES Ethical considerations <& This study was approved by the Institutional Review Board (RB)of he University of linois at Chicago and by each cooperating hospital Each participant signed a consent form prior to the interview and com pletion of the NDE Scale. Participants were assured that theiridentities would be kept confidential and that no identifying information would be published in any reports resulting from this stuas,notions elicited A pilot study showed that there were some strong en ncluding crying, from the interviews. We assured the participants that they were free not to answer any questions that made them uncomfort- able, and that they were free to terminate or reschedule the interview at any time. However, none of the participants indicated that he or she wished to end the interview prematurely. Confidentiality was assured by assigning each participant a code lumber. A master list of participants names and code numbers was kept in a locked office in the event that a participant needed to be con- tacted for further information, or scheduled for a follow-up interview. Results Patients'Level of Consciousness All 12 patient participants experienced a period of unconsciousness however, in many cases, it was difficult to assess the duration of the unconsciousness because the documentation in the medical record of- ten did not specifically identify level of consciousness. For seven of the 12 patients, the interviewer(L L M ) reviewed the records and corrobo- rated the patient's account of the experience. The remaining five med ical records were not available, most often because the patient was not recruited through a hospital Patients' NDE Scale scores Eleven patients completed the NDE Scale(Greyson, 1983), which was Ised to identify relative depth of the NDE. Determination of depth was made by sment of the number of features that were experienced during the nde and the degree to which they were experienced. The mean score of these 11 participants on the nde Scale was 14.5 (S D= 6), with a range of 4 to 25. The mean score on the Cognitive Component of the scale was 2.2(S D.= 2), with a range of 1 to 6 the

P1: GRA Journal of Near-Death Studies ph167-jond-455246 November 22, 2002 9:37 Style file version September 27, 2002 148 JOURNAL OF NEAR-DEATH STUDIES Ethical Considerations This study was approved by the Institutional Review Board (IRB) of the University of Illinois at Chicago and by each cooperating hospital. Each participant signed a consent form prior to the interview and completion of the NDE Scale. Participants were assured that their identities would be kept confidential and that no identifying information would be published in any reports resulting from this study. A pilot study showed that there were some strong emotions elicited, including crying, from the interviews. We assured the participants that they were free not to answer any questions that made them uncomfortable, and that they were free to terminate or reschedule the interview at any time. However, none of the participants indicated that he or she wished to end the interview prematurely. Confidentiality was assured by assigning each participant a code number. A master list of participants’ names and code numbers was kept in a locked office in the event that a participant needed to be contacted for further information, or scheduled for a follow-up interview. Results Patients’ Level of Consciousness All 12 patient participants experienced a period of unconsciousness; however, in many cases, it was difficult to assess the duration of the unconsciousness because the documentation in the medical record often did not specifically identify level of consciousness. For seven of the 12 patients, the interviewer (L.L.M.) reviewed the records and corroborated the patient’s account of the experience. The remaining five medical records were not available, most often because the patient was not recruited through a hospital. Patients’ NDE Scale Scores Eleven patients completed the NDE Scale (Greyson, 1983), which was used to identify relative depth of the NDE. Determination of depth was made by an assessment of the number of features that were experienced during the NDE and the degree to which they were experienced. The mean score of these 11 participants on the NDE Scale was 14.5 (S.D. = 6), with a range of 4 to 25. The mean score on the Cognitive Component of the scale was 2.2 (S.D. = 2), with a range of 1 to 6; the

点击进入文档下载页（PDF格式）

共29页，试读已结束，阅读完整版请下载

点击下载（PDF格式）

浏览记录