Thai Nurses’ Perceptions of a Good Death: An Integrative Review

Abstract

Thai Nurses' Perceptions of a Good Death: An Integrative Review I n Thailand, there was a total population of approximately 66.4 million at the end of 2018, 1 with an increase of total death from 456,391 to 473,541 cases (from 2015 to 2018). 2 The five major causes of death in Thailand are aging, heart failure, sepsis, primary hypertension, and diabetes mellitus. 3 The place of death occurs mainly at hospitals and homes. Thus, health care providers, especially nurses, have an opportunity to prepare to care for people who are confronted with death and dying. 4,5 Death is a natural phenomena that everyone has to experience and there is no escape from this. 5,6 According to the Thai cultural context, death has been perceived as taboo by Thai people. Consequently, they do not talk about death and there is a lack of preparation for death. 6 Those nearing death may also face emotional turmoil, including fear of death. 4 It causes people to fight for prolonging life, increasingly dependent on medical care services including medicinal use, invasive medical instruments, and cardiopulmonary resuscitation. 7 Although these treatments can extend life, these treatments can cause patients physiological, psychosocial, and spiritual suffering. 4,6,8 A good death is an important goal of caring for patients with end of life conditions or receiving palliative care. 4-10 A good death has not been universally defined because of the differences in individual perception, belief, and sociocultural context. Moreover, the meaning of a good death is different depending on patient's views, families, and health care providers. This may affect the patients' care in promoting a good death. [4][5][6][8][9][10][11] Thailand is different from western countries, particularly when it comes to spiritual and religious beliefs that are integral to the Thai way of life from the beginning of life to the end of life. The majority of Thai people are Buddhist accounting for more than 90%, Muslims accounting for 4% of the population, and others. 9,11,13 The difference in sociocultural context and belief have influenced the perception of good death among patients, families, and health care providers, which may be different in their views. Nurses have played important roles to promote a good death for patients nearing death. [4][5][6] Deep understanding of a good death from a nurse's perception is crucial for providing care to promote a peaceful death.

Relationship Between Intensive Care Nurses' Attitudes and Behaviors Toward End-of-Life Care and Ethical Attitudes

“…Nurses' experiences are important in order to provide physical, social, psychological. and spiritual care, considering all aspects of patients' care needs 35 . Also, in order for intensive care nurses to provide better care to dying patients and their families and to show correct knowledge and a positive attitude on this topic, it is necessary for them to receive education 6 .…”

Buen morir en la persona mayor:

“…En estos trabajos fue muy evidente la especificidad temporal del concepto, es decir, que los factores que contribuyen a un buen morir han variado a lo largo del tiempo, ya que las preferencias sociales han fluctuado y la tecnología médica ha avanzado; en consecuencia, las percepciones de estos factores son individuales (8). Sin embargo, se ha visto que la mayoría de estas recogen aspectos que incluyen experiencias de cuidado, para asegurar un buen morir, que involucran las dimensiones físicas, psicológicas, sociales y espirituales del cuidado holístico en el final de vida (11,29).…”

“…Se reconoce que brindar cuidados al final de la vida es una obligación tanto integral como ética de estos profesionales (28). Un estudio con personal de enfermería en Tailandia determinó la importancia de siete aspectos principales que deben recogerse para brindar un proceso de atención que lleve a la buena muerte del paciente: 1) la conciencia y aceptación de la muerte por parte del paciente y su familia, 2) la preparación para la muerte, 3) un muerte sin sufrimiento, 4) que ocurra en un ambiente privado, 5) que los pacientes puedan estar con los familiares o seres amados, 6) el respeto a la dignidad del paciente incluso después de la muerte y 7) involucrar las prácticas espirituales y religiosas respectivas para cada paciente (29).…”

“…Este ciclo se rompe cuando la persona alcanza la iluminación. Ser consciente del Samsara lleva al creyente a entender y aceptar la muerte (14,29). Por otro lado, se ha descrito que en el confucionismo, la muerte es un fenómeno que no puede comprenderse desde el pensamiento racional y que es parte del orden natural, y en el taoísmo, la vida se entiende como la misma entidad a la muerte, como expresiones diferentes del cosmos (14).…”

“…Desde la perspectiva de la espiritualidad, un estudio con enfermeras en Tailandia relata la importancia percibida en esta población en relación con invitar a figuras líderes espirituales a los lechos de muerte, así como a hallar consuelos en rituales que guardan algún significado espiritual especial para cada individuo, sin que esto incluya necesariamente una filiación religiosa particular (29).…”