CONTEXT: We reviewed the Veterans Health Administration (VHA) Bereaved Family Survey's (BFS) open-ended responses to understand end of life care (EOL) best practices for Vietnam and pre-Vietnam Veterans.
OBJECTIVES: To identify: 1) recommendations for improved EOL care enhancements for older Veterans 2) a model of best practices in EOL care for Veterans, and 3) any relevant differences in best practices between Vietnam and prior war eras.
METHODS: We examined five years of BFS data (n=2,784), collected between 2013 and 2017, from bereaved family members of Veterans focusing on 2 open-ended questions: 1) Is there anything else you would like to share about the Veteran's care during his last month of life? 2) Is there anything else you would like to share about how the care could have been improved for the Veteran? Applied thematic analysis identified successes and challenges in the experience of the bereaved of Vietnam and pre-Vietnam era Veterans.
RESULTS: Regardless of war era and death venue, a patient-centered approach to EOL care with readily available staff who: 1) provide ongoing support, comfort, honor, and validation; 2) routinely adjust to the patient's changing needs; 3) and provide clear, honest, timely, compassionate communication, was important to the bereaved. Consideration of the uniqueness of Vietnam Veterans is beneficial.
CONCLUSIONS: Patient-centered EOL care should include assigning a point of contact that follows the patient, educates the family on expectations, ensures the patient's changing needs are met, ensures the family has appropriate support, and communicates updates to family throughout the patient's care continuum.
The United States military began to experience a steady increase in suicide rates across all service branches at the inception of the wars in Afghanistan (2001) and Iraq (2003). As the number of suicide deaths increased, so did the number of affected survivors who seek postvention support. Unique issues that accompany suicide death may expose survivors to a more distressing and complicated grief process. Peer support has clinically been observed to be widely utilized by suicide loss survivors. This article explores unique issues accompanying military suicide loss, potential benefits of postvention peer-based support, clinical considerations, and future directions.
The new technologies have changed the rituals related to death: Creation of memorial webpages and of virtual tombs, celebration of death anniversaries are now common currency on the Internet. In spite of their disappearance among the living, the deceased continue to exist on the Web. They still receive messages from their relatives but also from strangers and are at the heart of discussions, prolonging their presence. New technologies have led to a new concept of time and of “where life ends.” Through the analysis of Facebook’s accounts devoted to Turkish martyrs, this article aimed to describe the new funeral rituals seen on the Internet.
To add to the dialogue regarding the long-term recovery and wellbeing of war and tsunami-affected women in Sri Lanka, we utilised the Conservation of Resources Theory (COR, Hobfoll, 2009) to inform an investigation of direct and indirect effects. The study was specifically designed to assess how traumatic exposure may represent a form of loss which may associate with related losses in the form of external and internal stigma which may then associate with poor mental health outcomes. The data for this study were collected in 2016 from a sample of 379 widowed women in Eastern Sri Lanka; participant spouses died in the civil war, in the tsunami, or from health or other problems. Our analyses yielded a model suggesting associations between remembered trauma event exposure from war and disaster, external stigma, internalised stigma and mental health symptom distress. Results further yielded direct and indirect effects suggesting that trauma may represent a form of loss, and potentially lead to distress through the weight and challenges of stigma.
Conquêtes et guerres sont des constantes de l’humanité. Les hommes se battent, se tuent, et après ? On enterre les morts, les survivants rentrent chez eux, mais certains ne sont pas morts et ne rentrent pas. Que sont-ils devenus ? Ils ont disparu et nul ne sait ce qu’ils sont devenus. Leur sort devient un souci pour la société, un chagrin pour leurs proches et un problème juridique en ce qui concerne leur famille, leurs biens, leurs créances. Rome a constitué très tôt dans sa très longue histoire, une des plus importantes armées du monde et a du faire face à des disparitions inexpliquées et répondre aux questions juridiques que cet état de fait posait. À sa suite, l’Histoire du Droit a conservé les réponses données pour les siècles qui suivirent, jusqu’à nos jours où des personnes par milliers, par millions, continuent à s’absenter, à disparaître volontairement ou non, partout dans le monde.
This qualitative case study describes the end-of-life care for a physically healthy, although psychologically dying man. The letters of Countess Moltke to her husband who was sentenced to death and executed during the Nazi regime were analyzed content analytically. Three content clusters emerged, namely, Caring, Comforting, and Providing meaning, all of which were stimulated by Attachment to the dying person and by Expression of empathy, respectively. It is demonstrated that during the final 6 weeks, her care was well adapted to the course of his dying. The findings are summarized by the allegory of the dancing couple.
Coping affects somatic and psychological outcomes. This article explores narratives in a book, Kamikaze Diaries: Reflections of Japanese Student Soldiers, which report on the ways of coping used by each kamikaze participant before and during military service. The purpose of this study is to observe the possibility of a trend in coping strategies and consider how these trends inform us about other populations facing imminent death. This study analyzed data and extracted meaning from the narratives in the book (thematic content analysis). Within the thematic content analysis, the Ways of Coping scale was used, which describes the coping strategies people use when facing problems. The most frequently used coping strategies before they entered the military were "Accept Responsibility," "Endurance/Obedience/Effort," and "Self-Control," while once in the military, they were "Accept Responsibility" and "Endurance/Obedience/Effort." All the coping strategies used by kamikaze pilots appeared to focus on the passive self, which may be the type of coping in other populations facing death.
BACKGROUND: Chronic lung diseases, such as COPD, are a growing health concern within the veteran population. Palliative care programs have mainly focused on the needs of people with malignant disease in the past, however the majority of those worldwide needing palliative care have a non-malignant diagnosis. Additionally, palliative care provision can often be fragmented and varied dependent upon a patient's geographical location. This study aimed to explore palliative care provision for veterans with non-malignant respiratory disease, and their family carers, living in a rural area of America.
METHODS: Qualitative study involving a convenience sample of 16 healthcare professionals from a large veteran hospital in Boise, Idaho. Data collection consisted of 5 focus groups which were transcribed verbatim and analysed using thematic analysis.
RESULTS: Healthcare professionals perceived that a lack of education regarding disease progression enhanced feelings of anxiety amongst veterans with NMRD, and their family carers. Additionally, the uncertain disease trajectory impeded referral to palliative and hospice services due to healthcare professionals own ambiguity regarding the veteran's prognosis. A particular barrier also related to this particular patient population, was a perceived lack of ability to afford relevant services and a lack of local palliative service provision. Healthcare professionals expressed that a compounding factor to palliative care uptake was the perceptions held by the veteran population. Healthcare professionals expressed that alongside aligning palliative care with dying, veterans also viewed accepting palliative care as 'surrendering' to their disease. Findings indicated that telemedicine may be a beneficial platform to which palliative care can be provided to veterans with NMRD, and their family carers, in rural areas using a digital platform.
CONCLUSION: Non-malignant respiratory disease is a life limiting condition commonly experienced within the veteran population. A new model of palliative care utilising a dynamic digital platform for this particular veteran population may provide an optimal way of providing efficient holistic care to areas with limited palliative services.
Pièce de théâtre courte de l’auteure qui a travaillé plusieurs mois avec des classes de CM1-CM2, Un Village sans papas raconte l’atmosphère dans un village au début de la guerre de 14-18 quand tous les papas sont appelés pour aller se battre. Blaise et Victor vivent chacun différemment ce qui se passe : le premier quand son père revient mutilé, le deuxième qui parle avec le fantôme de son père décédé.
Une pièce de théâtre touchante, qui se lit très vite et traduit bien l’ambiance de cette période avec les ressentis d’une adulte et de ceux des enfants. Au début ils jouent à la guerre avant de se rendre compte que certains papas ne reviennent pas car ils sont morts et que d’autres reviennent différents car mutilés et englués dans ce qu’ils ont vécu sur le front. Une pièce autour de la transmission des souvenirs.
Des contributions retracent l'histoire des sépultures, des monuments commémoratifs et des rites funéraires de la Première Guerre Mondiale en France et en Belgique, évoquent leur classement au patrimoine mondial de l'Unesco.
BACKGROUND: The objective of this scoping review is to identify and map the global literature on death, dying, and end-of-life experiences among refugees. The study aims at identifying gaps in the literature produced on the topic and informs areas for future research in the field.
METHODS:: We included articles that met the following inclusion criteria: (1) Population: Refugees and/or internally or externally displaced individuals due to wars, conflicts, nonnatural disasters, or emergencies; (2) Setting: End-of-life phase, dying, and death that took place following the refuge or displacement and reported after the year 1980; and (3) Study Design: All types of studies including but not limited to primary studies, narrative reviews, systematic reviews, news, editorials, commentaries, opinion pieces, technical reports, and policy briefs. A systematic search of the following electronic databases: Medline, Scopus, CINAHL, and JSTOR yielded 11 153 records. The search of the United Nations High Commissioner for Refugees database Refworld retrieved an additional 7510 records.
RESULTS:: Seven articles met our inclusion criteria. All articles were coauthored by scholars in universities/research institutes in high-income countries, and except for one, all were conducted in the country of the final settlement of refugees. One article adopted a qualitative approach, another article adopted a mixed-methods approach, one was a narrative review, and 4 articles were reviews of the literature. Three articles discussed access to medical/palliative care among older refugees, and 3 others addressed bereavement and death arrangements. Moreover, one article examined how transmigration and previous experiences from 2 cultural settings in home countries affect the contemplation of death and dying.
IMPLICATIONS:: Research on end-of-life experiences among refugees is sorely lacking. This study raises awareness of the need for empirical data on end-of-life challenges and palliative care among refugees, thus equipping humanitarian agencies with a more explicit and culturally sensitive lens targeting those with life-limiting conditions.
La représentation comique d’Adolf Hitler n’est pas un phénomène nouveau puisque des exemples de ridiculisation du Führer s’observent dès le début des années 1940, notamment dans des films de propagande antinazie comme The Great Dictator de Charlie Chaplin. Ce qu’il y a de plus troublant, trois quarts de siècle après la fin de la Seconde Guerre mondiale, c’est le traitement frivole et décontextualisé que suscite le tyran nazi. Pour en rendre compte, nous avons choisi d’analyser deux romans récents – Il est de retour de Timur Vermes et Dolfi et Marylin de François Saintonge – parce qu’ils permettent de réfléchir aux principaux enjeux qui émanent de cette forme particulière d’humour noir. Rire d’Hitler, ou autour de lui, ne fait pas que nous amener aux limites de l’acceptabilité sociale en matière comique; cela vient également tester notre lucidité devant les dangers que l’Histoire se répète.
From 1969 until the signing of the Belfast (Good Friday) Agreement in 1998, more than 3,600 people were killed as a result of violence in Northern Ireland. Brendan O’Hara describes a study that examined whether the Northern Ireland Troubles have impacted those working in palliative care, and whether any such impact has implications for the treatment patients receive.
Respect for the human body is a fundamental principle of health care. This article examines a selection of the work of three Polish poets who lived through the agonies of World War II. The author reflects on the lessons that can be drawn from their work for clinical care, including Palliative Care, the dignity of the human person and the nature of suffering.
One aspect of palliative medicine that has been underexplored is the perspective of veterans either facing critical life-limiting illness or at the end of life. The needs of veterans differ not only because military culture affects how veterans cope with their illness but also because exposure-related factors (combat and environmental) differ between military branches. In this paper, we describe two cases involving end-of-life care for veterans with combat trauma and describe individualized approaches to their care.
Military Veterans have made many sacrifices for our country and deserve high-quality care at end of life. The purpose of this article is to discuss the WW II, Korean and Vietnam Veteran population, and common concerns at the end of life. Areas of focus include spiritual and emotional needs, posttraumatic stress disorder, and pain management. Understanding of military/Veteran culture, the stoic mindset, and moral injury may provide foundational knowledge for nonmilitary home care and hospice clinicians to understand Veteran patients and their families. In addition, resources and other references are offered to enhance the knowledge of Veteran-related care.
During recent years culminating in 2018, we have been living in the shadow of the First World War. In 2017, I was fortunate to "win" a ballot ticket to attend the Centenary Commemoration of the 3rd Battle of Ypres, otherwise known as "Passchendaele", that was held on the 31st July in the Tyne Cot Cemetery.
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