Nursing 685
and
Social Work 856
SPRING, 2013
CARE OF THE DYING AND BEREAVED
THROUGHOUT THE LIFE SPAN
SCHOOL OF NURSING
and
SCHOOL OF SOCIAL WORK
THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Class will be held in the
School of Social Work
Tate, Turner, Kuralt Building
Room: 500
Mondays, 5:30 PM – 8:20 PM
FACULTY
Beth Black, Ph.D., RN
Assistant Professor, School of Nursing
5004 Carrington Hall
966-3613
beth_black@unc.edu
Denisé Dews, MSW
Clinical Instructor, School of SocialWork
Tate-Turner-Kuralt Building, Suite 335
962-6439
ddews@unc.edu
1
Nursing685 Sowo856
Care of the Dying and Bereaved Throughout the Life Span
Spring, 2013
Syllabus
Prerequisites: None. Undergraduate and graduate students from nursing, social work, and other
health science related disciplines may take the course.
Description
The overall focus of this course, designed for students from a variety of health sciences related
disciplines, is to gain an understanding of issues in working with dying and bereaved individuals
of all ages and their families, including families with diverse characteristics and experiences e.g.,
diversity in ethnicity, culture, socioeconomic status, education, and location. Various models for
providing care to the dying and bereaved will be discussed.
Credit Hours: 3
Objectives
By the end of this course the students will be able to:
1.
2.
3.
4.
5.
6.
7.
Identify their own attitudes and feelings toward death and grief and be aware of the
impact of caring for dying patients and their families on themselves in their professional
role.
Identify the impact of terminal illness, death, and grief on individuals of various ages and
their families.
Describe the interrelationships of variables which affect the ability of an individual and
family to cope with terminal illness, death, and grief (e.g. ethnicity, culture, poverty, rural
location, etc.)
Use a variety of theoretical perspectives in assessment and intervention with dying and
bereaved individuals.
Discuss the strengths and weakness of a variety of models of care for dying and bereaved
individuals.
Discuss selected ethical and legal issues that are involved in the care of the dying and
bereaved.
Critically analyze research related to the course material.
Methodology
Didactic, seminar and experiential methods will be used to present and discuss theoretical,
clinical, and research content of the course. Guest speakers will bring an added richness to the
course content. Small group discussions will be used to facilitate sharing and self-awareness.
Various audiovisual materials will be used. Selected papers and class presentations will be
expected.
Grades
Graduate students are graded on an H, P, L, system.
H = 94-100
P = 80-93
L = 70-79
F = 69 and below
Undergraduate students are graded on the A, B, C, D, F system, and the School of Nursing
grading scale will be used. Grading tools used for evaluation are included in the final pages of
this syllabus.
A = 95 - 100
A- = 92 - 94
B+ = 89 - 91
B = 86 - 88
B- = 83 - 85
C+ = 80 - 82
C = 77-79
C- = 74-76
D+ = 71-73
D = 65 – 70
F = < 65
Honor Code
THIS COURSE AND ALL RELATED ACTIVITIES WILL BE CONDUCTED ACCORDING
TO THE HONOR SYSTEM OF THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL
HILL.
The Honor Code and the Campus Code, embodying the ideals of academic honesty, integrity,
and responsible citizenship, have for over 100 years governed the performance of all academic
work and student conduct at the University. Acceptance by a student of enrollment in the
University presupposes a commitment to the principles embodied in these codes and a respect for
this most significant University tradition. Your participation in this course comes with the
expectation that your work will be completed in full observance of the Honor Code. Academic
dishonesty in any form is unacceptable, because any breach in academic integrity, however
small, strikes destructively at the University's life and work. If you have any questions about
your responsibility or the responsibility of faculty members under the Honor Code, please
consult with someone in either the Office of the Student Attorney General (telephone: 919-9664084) or the Office of the Dean of Students (telephone: 919-966-4042). For additional
information about the honor code, please also refer to the University website.
http://www.unc.edu/depts/honor. The Information for Students and Plagiarism sections are
especially helpful.
Policy of Disability Accommodations
Students with disabilities or medical conditions that may affect their participation in the course
and who may need accommodations should contact the Department of Disabilities Services (9628300) http://disabilityservices.unc.edu . Disabilities Services will notify the instructor regarding
recommended accommodations. Instructors will not provide accommodations to a student
without communication from Disabilities Services
Inclement Weather Policy
When possible, faculty will post an announcement on Sakai of any class cancellations. All
attempts shall be made by faculty and students to attend course activities. Students are
encouraged to explore alternative means of transportation (buses, carpool, walking) when they
do not feel comfortable driving because of weather conditions. However, we do not want
individuals to jeopardize their safety by traveling during hazardous road conditions. Given the
wide geographical region from which individuals commute, individual judgment is required.
The University Weather and Disaster Hotline will provide information about conditions and
closure of the University. The number is 919-685-8100.
3
Policy on Incompletes and Late Assignments
Professional practice and administration require attention to detail as well as timely completion
of assignments. The classroom serves as an environment in which to develop professional
practices such as meeting deadlines and producing high quality work. As such, class
assignments are expected to be completed on time and to represent the student’s highest level of
effort. If there are circumstances that prohibit the timely completion of an assignment, it is the
responsibility of the student to contact the instructor at least 24 hours prior to the assignment due
date. The instructor may grant an extension under certain extenuating circumstances, but may
choose not to grant an extension.
A paper is considered late if it is handed in later than the beginning of class on the day that it is
due. The grade for late papers will be reduced 10% per day, including weekend days.
Therefore, a paper that would merit a grade of 100 at the time class begins on Friday would
receive a grade of 90 if submitted later that day; a grade of 81 if submitted on Saturday; a grade
of 73 if submitted on Sunday; and a grade of 66 if submitted on Monday.
A grade of Incomplete is given on rare occasions when there is sufficient reason to warrant it. It
is the student’s responsibility to initiate a conversation with the instructor to request an
Incomplete; the instructor has no responsibility to give an Incomplete without such a request.
Course Requirements and points:
Class attendance, preparation, and participation
Group Presentation
Journal Article Critique & Class discussion
Book analysis
Chapter Discussion Questions (3 pts. each x 10)
Total
20
20
15
15
30
100 points
Description of Assignments
1. Class Attendance, Preparation, and Participation
Because of the nature of this course, class participation and attendance is very important.
You are expected to read and be prepared to discuss selected theoretical, clinical, and
research articles and textbook chapters related to class content.
Carefully selected audiovisuals will be shown in class. In addition, you are urged to see
other commercial, TV, and educational audiovisuals related to loss, death, and grief on
your own. These audiovisuals are integral to class discussions.
2. Class Presentation on Diversity in Religious/Cultural Views of Death, Dying and
Grief: Due date: 3/18 and 3/25
Small groups of students will work together to research the beliefs and practices of a
specific religious/cultural group that relate to illness, loss, suffering, dying, death, grief,
mourning rituals, and burial. Students should select a culture or belief system (religious,
ethnic, spiritual) that is different from their own.
The presentation should address:
1. What is known (from the literature) about attitudes toward dying and death (at
least five references)
4
2. What the beliefs about autonomy or self-determination regarding treatment or
end-of-life decision making are (i.e. in the belief system, how much information
does the dying person want, and who makes treatment decisions)
3. What the death rituals are (i.e. burial, cremation)
4. How bereavement plays out – are there any expected practices after someone has
died?
5. If there are any interventions that have been shown to be effective with
individuals of this culture or belief system. Describe them. If there is no data on
this, what interventions do you believe would likely be effective, and why?
You may interview an individual of that faith or culture, or patient/family of that
faith/culture experiencing an illness crisis. If you choose a formal religion, interviewing
a clergy person of that faith would be helpful.
All members of the group will participate in making a 45 minute class presentation on
your research findings; prepare a handout and bibliography to give to other students. Be
sure to make enough copies for each student in the class. We do not have access to a copy
machine before class.
3. Analysis of a published work related to death, dying or bereavement: Due 4/15
Read a novel, biography, or autobiography related to death, dying, grief, or loss. See list
at the end of the syllabus for ideas but feel free to choose something not on the list. DO
NOT WRITE A BOOK REPORT!! A short (one paragraph) concise description of the
contents of the book is sufficient. The majority of the paper should be an analysis of this
book focusing on a selected issue addressed in the book. This might include, for
example, family communication, family responses, losses incurred, pain responses, grief,
coping behaviors, peer responses, relationship to health care professionals, the helping
responses of others, or the perceptions of the individuals about life and death. Use
current references from textbooks, class readings, and references you locate to
substantiate your discussion. Use APA style, type the paper and include references.
Length requirements: 4-5 pages double space (not including title page and references).
4. Journal Article Critique: Due: 2/11
Select a research paper related to a clinical interest in your practice domain. In no more
than 2 double-spaced pages, describe the research problem, the methodology used by the
researchers, and their findings. Then describe how these findings may be used in your
clinical practice. (Obj. 7). You must send an abstract from the paper to course faculty for
posting on Sakai and be prepared to lead a brief discussion on 2/25 about the findings
from the paper and its usefulness in your practice.
5. Chapter Discussion Questions (10): These are due at the end of class on the date of
the assigned chapter reading (e.g. responses to discussion questions for chapters 3 and
4 are due January 28).
There are 14 chapters in the Kastenbaum text. Discussion questions for each of the
chapters have been developed and are posted on Sakai. Students are responsible for
completing 10 sets of discussion questions. Students may select any ten chapters.
All papers MUST be typed double spaced using APA 6th edition format.
5
CLASS SCHEDULE
(Subject to Change)
Please note: additional reading will be assigned during course
*indicates assignment due
Jan 14
Introduction and Overview (obj. 1)
Text reading: Chapters 1 & 2 of Kastenbaum text
Required additional readings (please read before first class):
 Wright, P.M. & Hogan, N.S. (2008). Grief theories and models:
applications to hospice nursing practice. Journal of Hospice and Palliative
Nursing, 10(6), 350-358.
 Stein, G. L., Sherman, P. A., Christ, G., & Blacker, S. (2005). Promoting
Effective Social Work Policy in End-of-Life and Palliative Care. Journal
of Palliative Medicine, 8(6), 1271-1281.
Please complete Student Information Sheet (in class)
Exercise: My Attitude and Beliefs (in class)
Class activity: Social Construction of Dying (in class)
Jan 21
Holiday
Jan 28
Death (obj. 2 & 6)
Selection of class presentation groups and topics
Text readings: Kastenbaum, Ch. 3 & 4
Additional required readings:
 Pomeroy, E. C. & Garcia, R. B. (2009). The grief assessment an
intervention workbook: A strengths perspective. Belmont, CA:
Brooks/Cole. Chapter 1 posted on Sakai
 Rando, T. A., Doka, K. J., Fleming, S., Franco, M. H., Lobb, E. A.,
Parkes, C. M., Steele, R. (2012). A call to the field: Complicated grief in
the DSM-5. OMEGA, 65(4), 251-255.
 Shapiro, E.R. (2008). Whose recovery? Of what? Relationships and
environments promoting grief and growth. Death Studies, 32(1), 40-58.
In class film: Bill Moyers series On Our Own Terms: Living with Dying
Feb 4
Dying and Bereavement in Later Life (obj. 2 & 3)
Text Readings: Kastenbaum, Chapters 6, 9, & 15
Additional required readings:
 Petasnick, W.D. (2011). End-of-life care: the time for a meaningful
discussion is now. Journal of Healthcare Management, 56(6), 369-372
 Krishna, Lalit. (2011). Nasogastric feeding at the end of life: a virtue
ethics approach. Nursing Ethics, 18(4), 485-494.
In class film: Bill Moyers series On Our Own Terms: A Death of One’s Own
Feb 11
Suicide and Violent Death (obj. 3, 4, & 5)
Text Readings: Kastenbaum, Chapter 7 & 8
6
Additional readings:
 Lester, D. (2006). Can suicide be a good death? Death Studies, 30, 511527.
 Feldman, D.B. (2006). Can suicide be ethical? A utilitarian perspective on
the appropriateness of choosing to die. Death Studies, 30, 529-538.
In class film: Self Made Man
*Article Review Due – in addition to the hard copy your bring to class, please
email a copy of the article to Denisé Dews so it can be posted for your
classmates to read prior to class on 2/25.
Feb 18
Death Rituals and the Funeral Process
Field trip: Funeral Home visit, begins at 6:00pm
Note: If there is a family visitation scheduled at the funeral home, we will meet in
class at 5:30pm. Directions and details will be posted on Sakai.
Text Reading: Kastenbaum, Chapters 11, 12, 13
Additional required reading:
 Hyland, L. & Morse, J.M. (1995) Orchestrating comfort: the role of
funeral directors. Death Studies, 19, 453-474.
 Moneymaker, K. A., & Traeger, J. (2007). Creating Space and Ritual for
the Time of Death. Journal Of Palliative Medicine, 10(1), 270-271.
 Atkins, J. (2012). Class Acts and Daredevils: Black Masculinity in Jazz
Funeral Dancing. Journal Of American Culture, 35(2), 166-180.
Feb 25
Article Review Discussion
Each student will lead a short discussion of the article you reviewed for1/30
assignment. This is informal – no PPT, just discussion.
Reading: Please read the abstracts of the papers your classmates reviewed and
will be discussing. They will be posted on Sakai.
March 4
Special Topics (obj. 4 & 5)
Additional Readings
 Bronstein, L. R. & Wright, K. (2006). The impact of prison hospice:
Collaboration among social workers and other professionals in a criminal
justice setting that promotes care of the dying. Journal of Social Work in
End-of-life and Palliative Care 4, 85-102.
 Linder, J. F., & Meyers, F. J. (2009). Palliative and end-of-life Care in
correctional settings. Journal of Social Work in End-of-Life & Palliative
Care, 5, 7-33.
 Soloman, R. M. & Rando, T. A. (2007). Utilization of EMDR in the
Treatment of Grief and Mourning. Journal of EMDR Practice and
Research, 1, 109-117.
Guest speaker: Diane Dolan-Soto, MSW, LCSW
March 11
Spring Break – ENJOY!
7
March 18
Student Group Presentations – Diversity in Religious/Cultural Views of Death,
Dying and Grief
March 25
Student Group Presentations – Diversity in Religious/Cultural Views of Death,
Dying and Grief
April 1
Hospice (obj. 1, 2,& 4)
Field trip: Hospice of Wake County, 200 Hospice Circle, Raleigh, begins at
6:00pm (be sure to allow for 30 minutes travel time from UNC-CH) Guest
speaker: Mark Philbrick, RN, MSN, FNP, Director of Education and Volunteer
Services;
Text Reading: Kastenbaum, Chapters 5
Additional Readings:
 Buck, J. (2011) Policy and the reformation of hospice: lessons from the
past for the future of palliative care. Journal of Hospice and Palliative
Nursing, 13(65), S35-S43.
 Nebel, S. (2011) Facing death together: exploring the conceptualizations
of hospice patients and family as a single unit of care. Journal of Hospice
& Palliative Nursing, 13(6), 419-425.
www.who.int/cancer/palliative/definition/en/ - the WHO’s most recent definition
of palliative care for adults and children.
www.nhpco.org - the National Hospice and Palliative Care Organization’s
website that addresses professional and policy issues related to end-of-life care.
Some of this website is for members only; much of it is for public use and
contains a wealth of information.
www.hospiceofwake.org - this is the website for Hospice of Wake County. It
explains their various services. Reviewing this site in advance of the field trip to
HOWC will make that visit more meaningful.
Apr 8
Perinatal Palliative Care & Childhood Loss
Text readings: Kastenbaum, Ch. 10
Additional required readings:
 Black, B.P. & Sandelowski, M. (2010) Personal growth after severe fetal
diagnosis. Western Journal of Nursing Research, 32, 1011-1030. (optional)
 Black, B.P. (2011) Truth telling and severe fetal diagnosis: a virtue ethics
perspective. Journal of Perinatal and Neonatal Nursing, 25(1), 13-20.
 Davis-Floyd, R. (2003). Windows in space and time: a personal perspective
on birth and death. Birth, 30(4), 272-277.
 Koogler, T.K., Wilfond, B.S., & Ross, L.F. (2003). Lethal language, lethal
decisions. Hastings Center Report, 33(2), 37-41.
 McCaffrey, M. (2011) Letters to the Editor: Lethality begets lethality. Journal
of Perinatology, 31,630-632.
 Price, S. K., (2008). Stepping back to gain perspective: Pregnancy loss
history, depression, and parenting capacity in the early childhood longitudinal
study, birth cohort. Death Studies, 32: 97–122.
8

Van Riper, M. (1997). Death of a sibling: five sisters, five stories. Pediatric
Nursing, 23(6), 587-594.
Guest speaker: Patti Gasparello, MSW, LCSW, Director of Kids Path, Hospice &
Palliative Care Center of Alamance-Caswell
Apr 15
Ethical Issues Related to End-of-Life (obj. 6 & 7)
Text reading: Kastenbaum, Chapter 14
Additional required reading:
 Lobb, E.A., Kristjanson, L.J., Aoun, S.M., Monterosso, L., Halkett, G.K., &
Davies, A. (2010) Predictors of complicated grief: a systematic review of
empirical studies. Death Studies, 34, 673-698.
*Book analysis due
Apr 22
Pot-luck – Beth Black - home – address and directions will be given in class
Required Textbooks:
Kastenbaum, R. J. (2012). Death, society, and Human Experience, 11th ed. Boston: Pearson.
Highly Recommended Books:
Pomeroy, E. C. & Garcia, R. B. (2009). The grief assessment an intervention workbook: A
strengths perspective. Belmont, CA: Brooks/Cole.
Walsh-Burke, K. (2006). Grief and loss: Theories and skills for helping professionals. Boston:
Allyn & Bacon.
Recommended:
Archer, J. (1999). The nature of grief. New York, NY: Routledge.
Lawton, Julia. (2000). The dying process: Patients’ experiences of palliative care. NY:
Brounner-Routledge.
Lipman, A.G., Jackson, K.C. & Tyler, L.S. (2000). Evidence-based symptom control in palliative
care. N.Y.: The Haworth Press.
Meyer, C. (1998). A good death: Challenges, choices and care options. Mystic, CT: TwentyThird Publications
Olson, M. (2001). Healing the dying. 2nd. Ed. Albany, NY: Delmar.
Reed, F.C. (2003). Suffering and illness: Insights for caregivers. Philadelphia: F.A. Davis.
Silverman, P.R. (2000). Never too young to know: Death in children’s lives. NY: Oxford
Univ. Press.
9
Journal Article Critical Appraisal Worksheet (Due Feb 11)
Criteria
Review
1) Is it clear what the study is
about?
(explain)
describes purpose of the study accurately and
critically appraises whether the purpose statement
matches the description of the research?
2) Is the sample and setting
adequately described?
(explain)
accurately describes sample (who participated, some
characteristic(s) of sample, how many participants)
and setting (where did study take place) +
critically appraises adequacy of researchers’ sample?
3) What are the main
variables or concepts?
4) Are the data collection
methods and
measures well described?
(explain)
5) What are the main
findings?
6) What are the strengths of
the research design (consider
design, measures, analysis,
sample, etc)?
7) What are the limitations or
weaknesses of the study?
8) Can I use this research in
my setting?
Why or why not?
accurately identifies variables or main concepts
studied + distinguishes between independent and
dependent variables when appropriate?
critically appraises the level of description and fit
between data collection methods/measures and study
purpose?
Points
Possible
1
1
1
1
complete list of main findings?
1
Correctly identifies > 90% of study strengths?
1
Correctly identifies > 90% of study limitations, using
analytic thinking to explore beyond what is explicitly
stated by the authors?
Thoroughly considers translation of research into
practice setting, comparing special population &
setting to research, suggests alternatives or next steps
in research to translate into practice. Compares to
other settings or literature (i.e., has read more than
one of the proposed research articles on this topic)?
9) Overall content
Including spelling and grammar
10) Discussion in class
Preparation, clarity
1
1
2
5
10
Points
Earned
Team Presentation Grading Schematic (Due March 18 & 25)
Creativity
2 pt.
_____
Adherence to assignment 4 pt.
_____
Class engagement
2 pt.
_____
Presentation content
8 pt.
_____
Handout(s)
4 pt.
_____
Book Analysis Grading Sheet (Due Apr 15)
Criteria
Short, concise description of book.
APA style & page length requirements (< 5pages)
Spelling & grammar
Use of appropriate references to substantiate topic discussion
Connected book to health care profession
Analysis and overall content: use of theoretical frameworks (development;
attachment; continuing bonds; grief theories; etc) to support your analysis;
scholarly discussion of the response to dying/grief/bereavement of 1 or
more characters or family experiencing a death.
TOTAL
11
Points
possible
1
1
2
2
2
7
15
Points
earned