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PERCEPTIONS OF NURSING FACULTY

TOWARD

NEAR-DEATH

EXPERIENCES AND DEATH BED VISIONS

by

Linda H. Moore

A Dissertation Submitted in Partial Fulfillment of

the Requirements

for the

Degree of

Doctor

of Education

Division of

Educational

Administration

Leadership and Higher Education Program

in the Graduate School

Texas A & M University-Corpus Christi

December 2010


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UMI Number:

3484576

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ABSTRACT

Perceptions of

Nursing

Faculty

Toward

Near-Death Experiences and Death Bed Visions

Linda H. Moore, Ed.D., Educational Leadership,

Texas A

& M

University-Corpus Christi, 2010

B.S.N., University of Texas Health Science Center,

San

Antonio, 1987

M.S.N.,

Radford University,

1990

Dissertation directed

by Dr.

Raul Prezas and Dr. James Walter

Nursing faculty perceptions toward near-death

experiences

and

death bed visions

were

explored using an electronic survey

that

encompassed quantitative

and

qualitative

methods.

A total of 3,673 surveys were sent out across the United States, including the

territory of Guam, and 571

nursing

faculty

participated

in the study.

The

average

participant was a

60-year-old female

who had either

a master's

degree

or a doctorate.

Additionally,

half of the

participants

had

worked with near-death

experience patients and

indicated

that they had

a

near-death experience. In

regard to nursing education and

leadership, nursing faculty strongly believed

that

students should be allowed to care for

patients who have experienced near-death events as well as to

conduct research in the

area. Qualitative findings revealed similar

themes

in patients who experienced death bed

visions and those

who

had near-death experiences. Numerous anecdotal accounts were

described by the nursing

faculty who participated in

the

study.

Recommendations

included incorporating content about near-death

experiences

and

death

bed visions

into

nursing curriculum and providing in-services

to

nurses through professional nursing

organizations that focus on near-death phenomenon events.

ii


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PERCEPTIONS OF NURSING FACULTY TOWARD

NEAR-DEATH EXPERIENCES AND

DEATH

BED

VISIONS

A Dissertation

B y

LINDA

H. MOORE

This dissertation meets the standards for scope and quality

of

Texas A & M University- -Corpus Christi and is hereby approved.

d.D.. Co-chair

aurR.

P

Pate, Ph.D.,

Cojfamit tee Member

K. Walter,

Ed.D.,

Co-chair

Bryant Griffith, Ph.D.,

Graduate Faculty Representative

Luis Cifuentes, Ph.D.

Associate Vice President

for

Research and Scholarly Activity and

Dean

of

GraduateStudies

December,

2010


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DEDICATION

The

dissertation

is dedicated to Mr.

Leonard Leos,

MSN, RN, St. Philip's ADN

Program Director who

wanted

so

much to make

his

Dean proud of him

by

completing

his

doctorate

in Public Health,

but

whose

life was cut

short prematurely

on September 14,

2010, at the age

of

51.

I V


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ACKNOWLEDGMENTS

The

writer

wishes to

acknowledge the

following individuals

who have done so

much to contribute to

the

success of the experience:

First,

I

would

like to thank Dr. Raul Prezas and

Dr. James

Walter,

who

never

doubted the abilities of

the

researcher to complete

the

research study.

I would like

to

thank Dr. Bryant Griffith, dissertation

committee

member and

professor who reminded students, "If you can persist, you can achieve."

I would like to

thank

Dr. Christopher Pate, Dean of Health Sciences St.

Philip's

College.

The

road

at

St.

Philip's

College has been rocky from the beginning to the end.

The researcher hopes to have obtained your respect for accomplishments achieved to

include the completion of my dissertation. Like Leonard,

I,

too, want you

to be

proud of

me.

I would

like

to thank

my

mother, Gwyn Hutton, and

my

deceased

father,

Dr.

Kenneth E. Hutton, for encouraging me in all life endeavors to strive toward excellence.

I would like to thank my two sons, Eric and Ryan. Your success in life

will

fulfill

the hopes

and dreams of

your father

and me. We love you

both

more than

you can

imagine.

Last,

but

never least, my husband, Terry, who has been at my side

along the

long

and difficult educational journey. Terry deserves to be hooded more than I

do.

All I can

say

is

that

I

love him

v


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TABLE OF

CONTENTS

DEDICATION iv

ACKNOWLEDGMENTS v

LIST OF TABLES ix

LIST OF

FIGURES

x

CHAPTER 1: INTRODUCTION 1

Background

of

the

Problem 1

Statement of

the

Problem 4

Theoretical Framework 5

Purpose

of the

Study 8

Research Questions

9

Significance of

the Study 9

Definition

of Terms

10

Glossary 10

Limitations of the Study 16

Assumptions of

the

Study 16

Organization

of

the Study 16

CHAPTER

2: LITERATURE REVIEW

17

Components

of

Near-Death Experiences and Death Bed Visions 17

Life-Span Perspectives of Near-Death Experiences 20

Pediatric Population 20

Adult

Population

21

Elderly Population

22

Personal

Anecdotes

of Death Bed

Visions 23

Attitudes toward Near-Death Experiences

23

Clergy's

Attitudes toward Near-Death Experiences 24

Hospital Nurses' Attitudes toward Near-Death Experiences 24

Hospice Nurses' Knowledge of and Attitudes toward Near-Death

Experiences 25

Physicians'

Knowledge of and Attitudes toward Near-Death

Experiences

25

Psychologists' Attitudes toward Near-Death Experiences 26

Attitudes toward Death Bed Visions 26

Scientific Basis for

Near-Death

Experiences

and

Death Bed Visions 27

Ketamine 27

Ibogaine 27

Dimethyltryptamine

28

vi


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Anoxic States 28

Cardiac

Arrests 28

Quantum Biomechanics 29

Philosophical and Theological

Meanings of Near-Death Experiences and

Death Bed Visions 29

Summary 33

CHAPTER 3: METHODOLOGY 34

Purpose

and

Research

Questions

34

Research Design 34

Participant Selection

35

Instrumentation 36

Data Collection 37

Data

Analysis 38

Summary 38

CHAPTER 4: RESULTS 39

Quantitative Findings 39

Participant

Demographics 39

Knowledge of Nursing Faculty of Near-Death Experiences 43

Attitudes of Nursing Faculty toward Near-Death Experiences

44

Attitudes of Nursing Faculty toward Near-Death Experience Patients 44

Qualitative Findings

45

Near-Death Experience Themes 46

Death Bed Vision Themes 49

Summary

49

CHAPTER 5: DISCUSSION, CONCLUSION,

AND

RECOMMENDATIONS

51

Introduction 51

Summary of

Results

and Discussion 51

Conclusion 55

Recommendations

for

Practice 57

Recommendations

for

Future Research

58

REFERENCES 59

APPENDIX A: NEAR-DEATH EXPERIENCE ACCOUNT OF A VIRGINIA

STATE TROOPER 69

APPENDIX

B:

DEATH BED VISION ACCOUNT OF A HOSPITAL

PATIENT 70

vii


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APPENDIX

C:

FAMILY MEMBER'S ACCOUNT OF HER MOTHER'S

DEATH BED VISION 71

APPENDIX D:

DRUG-INDUCED NEAR-DEATH

EXPERIENCE

ACCOUNT

73

APPENDIX

E:

IRB FORM 75

APPENDIX F: NEAR-DEATH PHENOMENA KNOWLEDGE AND

ATTITUDES QUESTIONNAIRE 78

APPENDIX G: SAMPLE COVER LETTER WITH CONSENT

INFORMATION 92

APPENDIX H:

REPORTS OF NEAR-DEATH EXPERIENCES AND DEATH

BED VISIONS TABLE 93

APPENDIX I:

RESULTS OF PARTICIPANTS' SCORES ON KNOWLEDGE

OF NEAR-DEATH EXPERIENCES

94

APPENDIX J:

RESULTS OF PARTICIPANTS'

GENERAL

ATTITUDES

TOWARD NEAR-DEATH EXPERIENCES 99

APPENDIX

K: RESULTS OF PARTICIPANTS' ATTITUDES TOWARD

CARING FOR

AN

NDE PATIENT 103

APPENDIX L: SAMPLE OF PARTICIPANTS' UNALTERED REPORTS OF

NEAR-DEATH EXPERIENCES 107

APPENDIX

M:

SAMPLE

OF PARTICIPANTS'

UNALTERED REPORTS OF

NEGATIVE "HELLISH" NEAR-DEATH EXPERIENCES

AND DEATH BED VISIONS 110

APPENDIX N: SAMPLE OF PARTICIPANTS' UNALTERED REPORTS OF

DEATH BED VISIONS Ill

APPENDIX O:

SAMPLE OF PARTICIPANTS' UNALTERED REPORTS OF

AFTER-DEATH VISITATIONS 112

BIOGRAPHICAL DATA: LINDA

MOORE 113

Vlll


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LIST

OF

TABLES

1. Participant

Consent

39

2. Participant

Ethnicity 40

3. Participant Educational

Level

41

4.

Participant Religious/Spiritual Background 42

I X


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LIST OF FIGURES

1. Theoretical framework

8

2. Triangulation-convergence design model

35

3. Near-death experience and

death bed

vision themes 46

x


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1

CHAPTER 1

INTRODUCTION

The "near-death experience" is

a

topic evoking strong feelings either positively or

negatively. Physicians

and

nursing practitioners

and textbook

publishers

often dismiss

the

"death

bed"

phenomena as a

hallucination or drug induced. The medical community

finds it acceptable

and

preferable

to

keep the concept away from pre-service nursing

students.

The cursory dismissal

is not the best way

to educate nursing students to deal

with patients or

families of

patients when the

phenomena occur.

Effective

leaders

have the capacity to create and motivate and to never be

satisfied with the status quo. Effective leaders

create

new paths and effective leaders are

not

constrained by

conventional

methods or standard operating procedures. Effective

leaders

work

to

create change

and to

bring about new understanding.

Effective leaders

are

willing

to take responsibility, complete duties and hold

a

mental toughness despite

criticism.

The chapter presents an introduction and overview of the dissertation. The

chapter begins

with

the background

of

the

problem, followed

by the

statement

of the

problem, theoretical framework, purpose of the study, research questions, significance of

the study, definition of terms, glossary, limitations, and assumptions. The chapter

concludes with the organization of the study.

Background of

the

Problem

A controversial topic,

especially

among healthcare providers, is

patients'

experience of

a

phenomenological-spiritually-based encounter (Greyson, 2008). The

near-death experience (NDE) has been reported by increasing numbers of patients


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2

receiving

care in and

out of

healthcare

facilities. According to

a

Gallup poll,

reported by

the

International Association of Near-Death

Studies

(2008),

over

13

million

Americans,

not including children, have reported having had

an

NDE as

a

result of a close encounter

with death. An NDE can

be

summarized as

a

close encounter with death, and many of

the experiences are described as

a

spiritual metamorphosis (Greyson,

1985;

Moody,

1975,

1988;

Ring, 1984). An NDE has 15 distinct

attributes,

one of which

is

indescribable knowledge (Greyson,

2005).

Flew (1955) addressed the concept of indescribable knowledge in philosophical

terms. Flew believed that events are interpreted within philosophical meanings and that

reasonable inductions are part

of

the behavioral patterns and beliefs engendered in the

human species.

There is

a

world of difference between saying that it is reasonable in certain

circumstances to act

inductively (which is

a

value matter, one of

commending

a

certain sort of behavior); and saying that most people regard

it

as reasonable so to

act (which is a factual matter

one

of neutrally giving information about that kind

of behavior). Thus that too short way with the problem of induction, which tries

to deduce that induction is reasonable from the premise that people regard it as so

or even from the fact that they

make

inductive behavior part of their paradigm of

reasonableness, will not do: it is necessary for each of us tacitly or explicitly

actually to make our own personal value commitments here. Most of us are in

fact willing to make that

one

which is involved in making inductive behavior part

of

our

paradigm

of

reasonableness

(pp. 35-36).


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3

Other components

of

an NDE include hearing about one's own demise, usually

vocalized by healthcare professionals; a feeling of peace and serenity engulfing the

experiencer;

unusual

noises, varying in description from distant bells ringing to a sound

similar

to a

buzz

saw;

an out-of-body experience (a hovering-type experience whereby

the individual

sees occurrences in present

time

as if viewing

a movie;

seeing

a

tunnel

with

incandescent

lights illuminating a path

toward spiritual

enlightenment;

seeing

beings

of light,

representing deceased relatives

and/or

higher spiritual creations; meeting a

Supreme

Being, identified

by

many as one of

the

Trinity;

conducting a

life review;

feeling that

one is

at

the

edge of no

return,

often

equated

to a cliff whereby the

individual

is offered a choice of whether

to

return to the

body

or move into death; returning

to

body,

with ambivalent feelings described as

a

sudden jolt of intense pain

at

the moment of

return; informing others of one's death, expressed

by

the experiencer with hesitation for

fear of being discounted; undergoing personal adjustments, resulting

in

changes in

lifestyle and beliefs; a change in attitude toward

dying, with decreased fear

of

death;

and

collaboration

of

the experience, engaging

in

thoughtful interaction with others having

experienced the phenomenon (Perry, 1988).

Family

members have

reported incidences in which

a dying

relative displayed

characteristics

of engaging

in

conversations with (invisible) images of deceased family

and

friends.

Death bed visions (DBVs)

are

frequently

witnessed

by families

sitting with

a

dying loved one, who reports such visions (Wills-Brandon, 2000). Accounts of the

appearance of ghostly apparitions

at

the time of death

have

been recorded

by

individuals

dating

from ancient

times (Brayne, Farnham, & Fenwick, 2006).


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4

NDEs

and

DBVs have an enormous impact on both

the patient

and family

members (Greyson, 1997). The direct care nurse charged with holistic care must be

knowledgeable and accepting of NDEs and

DBVs

to provide

culturally

competent care to

both the patient and

family members. The importance of ensuring

that the direct-care

nurse has received instruction, allowing for exploration of near-death phenomena, cannot

be underestimated (Brayne, Lovelace, & Fenwick, 2008).

The nursing educator

is the individual who provides initial

mentoring

of the

student nurse and prepares

the

student nurse for a lifelong career in

the

comprehensive

delivery of care to patients and families of patients (McGovern-Billings &

Flalstead,

1998).

The

licensed

nurse

is

generally

the

first licensed

healthcare professional

to

encounter a patient

having

an NDE or a DBV

(Texas

Board

of Nursing,

2009).

Statement of the Problem

Near-death phenomena

have been discussed by

some

professionals and have

received media coverage

through movies, talk shows, newspaper articles, books,

magazines, and research journals

(Parnia, 2008).

Discussions have taken place

among

experienced researchers and healthcare providers, including critical care nurses (Oakes,

1981), psychologists

(Walker

& Russell,

1989), hospice

nurses (Barnett,

1990) and

physicians (Moore, 1994).

Nursing textbooks do not contain information about NDEs or DBVs (D. Dobbs,

personal

communication, March 18, 2009).

The

lack of coverage in textbooks gives

the

message that NDEs and DBVs are not important enough to include in the comprehensive

education

of nursing students and

mitigates against

their

being

discussed

by

nursing

students.

As a

result, nursing students are currently

unprepared

to engage patients and


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5

families of patients encountering NDEs and

DBVs (R.

Spruill, personal communication,

February 10, 2009). Although there is recognition that exploration of NDEs and DBVs is

important to providing holistic, culturally competent nursing care,

no

research that

involves a comprehensive exploration of knowledge and attitudes toward NDEs or

DBVs

among nursing educators has been conducted.

Theoretical Framework

An

understanding of NDEs and DBVs is

part

of a multi disciplinary

phenomenological

model that

takes

into

account the psychosocial, spiritual, and

philosophical

aspects

of

NDEs

and

DBVs (Corcoran,

1988).

Research from

the

perspective indicates

that

the NDE is

an

authentic phenomenon that

is

essentially

the

same in whatever country or culture

it

occurs. The only difference seems to be that the

individual will see the religious idol pertaining to

his/her

religion. There seems to

be

no

correlation with religion, age, sex, educational background, financial status or psychiatric

history (Cole, 1993, p. 157).

The theoretical framework,

Watson's

(1988) Model of Human Caring, coupled

with

Flew's

(2007) concept of human perceptions,

provided the

foundation for

the

research.

Watson's Model

of

Human

Caring, more

specifically, the

Actual

Caring

Occasion (ACO), contains an acknowledgment of NDEs

and DBVs

(Watson, 1994),

which comprise the ACO. The ACO is

a

multidimensional phenomenological experience

that is

greater

than

the sum of its caring events, and

it

views individuals engaged in the

therapeutic

experience

as part

of

the

whole caring

phenomenon

(Watson, 1985).

The whole caring-healing-loving consciousness is contained within

a

single

caring

moment.

The one caring and the one

being

cared for are interconnected;


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6

the caring-healing process is connected with

the other

human(s) and

the

higher

energy of

the

universe;

the

caring-healing-loving consciousness of the nurse is

communicated

to

the one being cared

for; caring-healing-loving consciousness

exists

through and

transcends time

and

space

and

can

be

dominant over

physical

dimensions. Within this context,

it

is acknowledged that

the

process is relational

and connected; it transcends

time,

space and physicality. The process is

inter

subjective

with

transcendent possibilities

that go

beyond the given

caring

moment (Watson, 2010, pp. 116-117).

Watson and

Foster

(2003) emphasize

the

importance

of

maintaining

the

caring-

healing process as

a

continuous plan of patient care, stating:

The dynamics of relational, human-to-human caring practices and comprehensive

therapeutic

modalities

for

caring-healing seem to be eclipsed by

the

daily

routines, mechanics and demands of economic, management, physical and

technological aspects of care.

The heart of the necessary changes needed for

renewal and transformation seem to

be

dependent

on

human dimensions and skills

that result in transforming patterns and depths of communication, relationships

and healing modalities. These human caring-healing dimensions transcend

profession, system

and

institutional

structures (p.

361).

Individuals experiencing the

ACO

include the nursing faculty, of which

the

nursing

student is

a

part.

Flew's (2008) perspective allows for

the

experience of NDEs and DBVs. He

defined perceptions as sensory events that individuals experience

and

believes that

having faith is justified.


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7

It

remains to consider

the possibility

of there

being

evidence

which,

though

less

than decisively probative, might nevertheless

be

sufficient to justify bets of faith.

As my Father,

a

Methodist preacher often said in sermons: 'Faith is not

a

leap in

the dark but a

leap

towards the Light ' (Flew, 2010).

In

keeping with Flew's perspective, Taylor and Watson (1989) believe that

NDEs

and

DBVs

are

actual human sensory experiences exemplifying

the

phenomenal fields

created within

the

ACO.

Nursing faculty, who contribute to the caring-healing process through mentoring

students, need to have certain characteristics: (a) spiritually supportive of

the

nursing

student;

(b)

competent in nursing abilities; and (c) providing nonjudgmental therapeutic

communication. Additionally, nursing faculty must

be

knowledgeable about NDEs and

DBVs

and must

acknowledge

patient

sensory perceptions (Watson, 1999, 2005). That

nursing faculty should acknowledge and discuss NDEs and

DBVs

illustrates the

significance attached to patients' sensory experiences (Bevis & Watson, 1989).

Acceptance

of

the existence of NDEs

and DBVs allows the providing of holistic spiritual

care by

the

faculty member and the nursing student. Flew (1977) wrote about care as

related to

knowledge

and

emphasized the

importance of

an individual's belief system.

Care is also always required about knowledge and refutation. To say that

someone knows something

is

to

say

more than

he claims

to know it,

or

that

he

believes

it

most strongly.

It

is

to say also, both

that it is

true, and that

he is

in

a

position to know. So neither the sincerity of

his

conviction nor the ingenuousness

of

his

utterance guarantees that he knew. . . If you

do

not want

to

say as

much

as

that, then you should take the trouble to

be

non-committal. You ought to say


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8

only:

in the

one case, that he believed,

and claimed

to know.

. .

In

the all

too

common abusage I have my opinions and my convictions,

but

you and he merely

have

prejudicesso called for

no

better

reason

than that

they

are

yours or his and

not mine (pp. 28-29).

The combination of Watson's theory of caring and Flew's concept of human

perceptions

creates

a foundation for studying perceptions of

NDEs and

DBVs of

healthcare professionals. The theoretical framework is presented in Figure 1.

First Field

Past

History

The RN that

will become

the Nursing

Faculty

who

is providing

care

to

the

Patients /

Families

who

have

had NDEs

and DBVs.

ACO&

H u m a n

Perceptions

Second

Field

Present Flistory

The

Nursing Faculty

mentors the Nursing

Student and

engages

in holistic

&

open

dialogue that

supports those

attributes of Human

Caring toward the

goal

of learning &

understanding

NDEs and DBVs

by

way

of simulation.

ACO&

Human

Perceptions

Third

Field

Future History

The Graduate

Nurse

is

now equipped

with

the

holistic knowledge

and

attitudes which were

engendered by

the

Nursing

Faculty

to

care

for Patients /

Families

who

will report

having

had

NDEs

and

DBVs

& will now be able to

provide holistic &

culturally

competent

care

for

these clients

and their families.

ACO&

Human

Perceptions

Figure 1. Theoretical framework.

Purpose

of

the

Study

The primary purpose

of

the

study was to assess knowledge (beliefs), attitudes, and

views of nursing faculty toward

NDEs.

The secondary purpose was

to

explore

perceptions of nursing faculty toward

DBVs.

Nursing instructors

mentor nursing

students

who will be

responsible for

the

direct

care of patients and their families, including patients experiencing NDEs and DBVs. The


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9

nursing

instructor is

in a

position to introduce nursing students to the psychosocial

and

spiritual aspects of near-death phenomena, including NDEs and DBVs.

Nursing faculty can potentially have

a

positive impact on

the

nursing

student's

ability to engage patients and families who report near-death phenomena. If the nursing

instructor demonstrates a lack

of knowledge

or negative

attitudes toward

NDEs and

DBVs,

healthcare delivery would

not be

compassionate. Ascertaining

the

attitudes

of

nursing faculty has implications for

the

education of nursing students, particularly

because

discussion of

NDEs and

DBVs

is not

included in nursing textbooks.

Research Questions

1. What do nursing faculty know

about

near-death

experiences?

2. What are the attitudes of nursing faculty toward near-death experiences?

3. What are

the

perceptions of

nursing faculty

regarding near-death experiences?

4. What are

the

perceptions of nursing faculty regarding

death

bed visions?

Significance

of

the

Study

NDEs

and

DBVs are considered

to

have spiritual

implications

for patients

and

families having

had

these types of encounters. Thus,

it is essential

to ensure that first-line

licensed healthcare providers (i.e., nurses) have received adequate education about these

experiences.

Lack of knowledge of these phenomena by the nursing faculty would be

detrimental to student nurses and

the

delivery of competent

holistic

care once they are

licensed

as

professionals. The nursing faculty member plays

a

key role

in

the mentorship

of the nursing student by engaging in dialogue about near-death

phenomena,

enabling

graduate

nurses to provide

culturally

competent

care

to clients

and families

who

may

encounter NDEs

and DBVs

(Wells, 2000). The study allowed exploration of knowledge


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10

and attitudes toward NDEs as well as of

awareness

of patients having reported

DBVs.

The

study also identified the need

for information on

NDEs and DBVs in

nursing

textbooks.

Definition

of Terms

The following

terms

were operationalized for

use

in

the

study:

Altitude is

a

predisposition including behaviors, feelings, perceptions,

and

thoughts about certain phenomenon (Kerlinger, 1974). Attitude, for the purpose of the

study, was operationalized as the Likert-scaled responses

to the

attitude portion of

The

Near-Death Phenomena Knowledge and Attitudes Questionnaire

(Thomburg,

1988).

Knowledge is

the awareness

of being familiar or

aware

of something that is

gained through

life

experiences

("Knowledge" 2009).

Knowledge, for the purpose of

the

study, was operationalized

as

the Likert-scaled

responses to the

knowledge portion

of The

Near-Death

Phenomena Knowledge

and

Attitudes Questionnaire (Thornburg, 1988).

Perceptions are

statements

or

views

that

are identified through

individual

responses that

may be

anecdotal in nature (Patton, 1990).

NDE

and DBV perceptions

were measured and documented by analyzing and synthesizing the

focus

group

participants' qualitative data.

Glossary

Abdominal

pain

is an uncomfortable sensation in the stomach and/or epigastric

region of

the

body

(Smeltzer,

Bare, Hinkle,

&

Cheever,

2009).

Actual caring occasion (ACO)

is

a

transcendental, shared experience

between

nurse and patient,

facilitating

the

essence of caring,

healing, and

wholeness (Watson,

2010).


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11

Adenoidectomy is a surgical removal of the adenoids, a lymphoid tissue located in

the nasopharygeal region (Como, 2006).

Anoxic is the absence of oxygen to vital

organs

or

body

tissues resulting in

physiological

deterioration (Potter & Perry, 2007).

Arrest is a

cessation of

physiological

activities (Como,

2006).

Artificial

life

support is artificial means, typically of

a

mechanical nature,

necessary to keep an individual alive

(Linton, 2007).

Breast

cancer is

an abnormal condition involving malignant or benign cell growth

in

the

breast region of

the

body

(Ricci, 2009).

Cardiac

arrest

is

the

cessation of

the heart

beat

(Perry

&

Potter, 2007).

Cardiac

bypass

surgery is a surgical

procedure that involves

the

replacement

of

diseased heart vessels with synthetic or donor

site

vessels to facilitate blood

flow

to

the

heart (Smeltzer

et

al., 2009).

Cardiac patients are individuals who have been diagnosed with heart disease by

a

physician

(Dirksen

et al., 2010).

Cardiologist is the physician who

specializes

in the physiology

and care

of the

heart (Smeltzer et al., 2009).

Cardiopulmonary resuscitation (CPR) is the

process of externally supporting

the

circulation and respiration of

a

person whose heart has arrested (Dirksen,

O'Brien,

Lewis,

Heitkemper,

&

Bucher, 2010).

Carative is

the

act of caring (Potter & Perry, 2007).


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12

Chronic renal failure

is

the presence of kidney damage for at least three months,

with functional or structural

abnormalities

of

the

kidneys,

with

or

without

decreased

glomerular

filtration rate (Dirksen

et al.,

2010).

Critical care

is specialized care administered

to patients

who are

found to

be

too

sick

to

remain on a routine

hospital unit (Dirksen et al.,

2010).

Culturally

competent

care is a state in which the healthcare

professional

understands

and

attends

to

the total

context of the patient's situation (Spector, 2004).

Death

bed visions (DBVs) are

reports

of

visitations

from

deceased loved

ones

or

those

experiences that are in the spiritual or heavenly realm

(Critchley, 2008).

Diabetic ketoacidosis is caused by a profound

deficiency

of insulin and

is

characterized by high blood sugar, ketosis,

acidosis,

and dehydration (Dirksen et al.,

2010).

Dimethyltryptamine

(DMT) is

a drug that

has

psychedelic

properties

that is

found

not only

in

many

plants, but also in the

human

body, where its natural

function

has not

yet been identified (retrieved from

http://www.erowid.org/chemicals/dmt/dmt.shtml,

2010).

Direct-care

nurse is

a

licensed healthcare

provider

who provides comprehensive

holistic care

to

patients

(DeWitt, 2009).

End-of-life

experiences (ELEs)

are

experiences that are reported

by

individuals

prior to death

(Fenwick,

Lovelace,

&

Brayne, 2007).

Emergency department is

the triage area of a hospital (Potter

&

Perry, 2007).

Emergency

medical

technician (EMT) is a

specially trained individual who

attends to the

care

of individuals outside

of

a

hospital setting

(Como, 2006).
http://www.erowid.org/chemicals/dmt/dmt.shtmlhttp://www.erowid.org/chemicals/dmt/dmt.shtml


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13

Graves' disease

is

a

condition that involves the hyperactivity of the thyroid gland

with

a

sustained increase in synthesis and release

of

thyroid hormones (Dirksen et al.,

2010).

Holistic care is

a

method of providing care to

a

patient and family that considers

spiritual, physical, emotional,

social,

and economic needs (Como, 2006).

Hyperosmolar coma is a life-threatening syndrome that can occur in the patient

with diabetes mellitus who is

able

to produce enough insulin to prevent diabetic

ketoacidosis but

not

enough to prevent severe hyperglycemia, osmotic diuresis, and

extracellular fluid

depletion

(Dirksen et al., 2010).

Hypoxia is

decrease

of

oxygen to vital organs or

body

tissues resulting

in

physiological

deterioration

(Leifer, 2007).

Ibogaine is a substance found in a number of plants that

has

been used typically in

rituals and medicinal

purposes

and

most

recently

has been studied

as a potential

drug to

arrest drug addiction

as it relates

to

alcohol,

cocaine,

heroin,

and methadone

(Physician's

Desk

Reference, 2010).

Ketamine

is

a

drug that

is

administered

at low

doses and upon emergence from

anesthesia that produces changes

in

mood

and

body image

as well as

hallucinations

(Physician's Desk

reference,

2010).

Knowledge is

belief

that an individual ascertains to

be

truth (Flew, 1977).

Licensed nurse is

the

first-line licensed healthcare professional who provides

direct

patient

care under the scope of practice as identified by

a

state board of nursing

(Harrington

&

Terry, 2009; Texas

Board

of Nursing,

2009).


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14

Medical intensive

care

is a

specialized

critical care area

designed for

a variety of

patients

who are too

sick

to remain

on a

routine hospital

unit

(Como, 2006).

Multidimensional phenomenological-spiritually-based experience is

a

transcendental experience that includes time, space, and the

physical

environment

(Watson, 2010).

Myocardial infarction

(heart

attack) is lack of oxygen resulting in damage to the

heart

muscle (Perry

&

Potter, 2007).

Near-death

experience

is

a

spiritual event encompassing one

or

more

of

15

attributes at a

time of death

or

with

a

close

brush

with

death.

These include: (a)

indescribable knowledge,

(b) hearing of

one's death,

(c)

peaceful sensations, (d)

unusual

sounds,

(e)

out-of-body experience, (f) a tunnel,

(g)

ghostly

spirits

of light,

(h)

introduction

to

a supreme being

of

light, (i) life

review,

(j) border of

no

return, (k)

returning to the body,

(1)

informing others,

(m)

personal life adjustments after the

experience, (n)

attitudes toward

death

and

dying,

and (o)

collaboration

of

the experience

(Moody, 1975, 1988). The terms near-death experience, NDE, near-death phenomenon

and near-death phenomenon event, for the purpose of

the

study, were used

interchangeably.

Neurological system is an extensive physiological system of the body that

provides for

brain function,

thought,

speech, vision,

and

movement

as well as

physiological control of the human body (Estes, 2010).

Nonjudgmental therapeutic communication is the foundation

of

developing

a

positive nurse-patient relationship (Videbeck, 2008).


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15

Nursing faculty includes nursing instructors who

teach

or precept entry-level

nursing students in a variety of nursing curriculum. Nursing faculty, for the purposes of

the study,

was

defined as nursing

educators

who are members of the National League of

Nursing (NLN).

Palliative

measures

are

those

that provide comfort, but

that

are

not curative in

nature,

for

patients who

are

dying (Potter

&

Perry, 2007).

Perceptions

are actual human sensory experiences that

an

individual encounters

Flew, 2007).

Perspectives are

perceptions

(Marshall & Rossman, 2006).

Radical surgery typically results in surgery of

a nature that

is

disfiguring but

necessary

for

survival (Como,

2006).

Recreational

drugs are

drugs or

chemicals

that

have the potential to alter

an

individual's perception of reality (Stuart & Laraia, 2005).

Reflex anoxic seizures

(RAS)

is a seizure disorder occurring

in

children that may

be triggered by sensations of pain

or

fear (Blackmore, 1998).

Respiratory

arrest is cessation of breathing (DeWitt, 2009).

Stroke

is blockage of blood

flow

to

the

brain resulting in neurological damage that

may

be

temporary or permanent

(DeWitt,

2009).

Thoracic pain is pain in the region of the chest, typically associated with a cardiac

or pulmonary

focus

(Perry

&

Potter, 2007).

Tonsillectomy is the surgical removal of

tonsils

(Linton, 2007).

Terminal

state

is a physiological state in which there is no basis for recovery

(Feldman,

2008).


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16

Limitations of the Study

The study was

conducted using

a non-probability sample of nursing faculty who

are

members of

NLN.

Thus, external validity was limited to nurses who

are

members of

that

organization.

Assumptions of the Study

The study has

several

assumptions.

First, it was

assumed that

the nursing

faculty

had

experience

as

a deliverer

of patient care

but

may

not have

cared

for patients

and

families who have reported NDEs

or

DBVs. Second,

it

was assumed that

the

nursing

faculty were willing participants in the study. Third,

it

was assumed that nursing faculty,

based

on the

results

of the study, would

be open

to the possibility of

introducing

the

topics of NDEs and

DBVs

into the nursing curriculum.

Organization

of

the Study

The chapter has provided an introduction to and an overview of

the

study.

Chapter

2

presents a review of the literature on

NDEs

and DBVs, including components

of NDEs and DBVs, life-span perspectives of NDEs, involving the pediatric,

adult,

and

elderly populations, assessment of knowledge of and

attitudes

toward

NDEs

from the

perspectives

of

health care

and

ancillary professionals, a scientific perspective of

the

reasons for

NDEs

and DBVs, and philosophical

and

theological meanings of NDEs and

DBVs.

Chapter

3

presents

the

methodology for the study, while Chapter 4 presents

both

the

quantitative and qualitative findings. Chapter 5 provides

a

summary of

the study,

followed by

a discussion, conclusions, and recommendations for nursing leadership and

for further research.


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17

CHAPTER

2

REVIEW

OF

THE

LITERATURE

Academically recognized

data search engines

(CINAHL Plus

with

Full

Text;

Health-Wellness Resource

Center; PsycINFO; ProQuest; EBSCO;

Religion &

Philosophy

Collection and

Google

Scholar)

contained little research on NDEs

and DBVs,

particularly in regard

to knowledge

and

attitudes

of nursing faculty

regarding near-death

phenomena.

The empirical studies that were found used

quantitative

methods to evaluate

the NDEs

of patients. Few

studies

were found that concerned patients

and

family

members reporting DBVs. The majority of articles reviewed were qualitative-driven

anecdotal accounts that

focused

on individuals having

had NDEs.

One

qualitative article,

however,

focused on

the

perspectives of healthcare professionals

toward

DBVs. No

articles,

however, were found assessing knowledge and attitudes

of

nursing faculty

toward

NDEs

and DBVs.

Based on the relevant literature that

was found, the

review is organized as

follows: (a) components of NDEs and DBVs; (b) life-span perspectives as seen in

anecdotes of NDEs;

(c) anecdotes of DBVs; (d) knowledge and attitudes of

healthcare

professionals and other paraprofessionals toward NDEs;

(e)

scientific basis for NDEs

and

DBVs;

and (f) philosophical and theological meanings

of

NDEs and DBVs.

The

chapter

concludes

with a summary.

Components of Near-Death Experiences and Death Bed Visions

The term

near-death experience was

first

used

by

Moody

(1975)

and has

been

described

by

millions

of

individuals around the

world.

Duffy and

Olsen (2007)

emphasize the descriptive

components

of

NDEs. As

described

by

patients,

NDEs

include


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(a) a sense of separation from the

physical

body; (b) a tunnel of

light;

(c) meeting

deceased

relatives, friends, and

spiritual

entities;

(d) life

review; (e) a sense of peace;

and

(f) returning to one's body, knowing that the experience was real. Duffy and Olsen

provided no statistical information, only reports of NDEs of patients.

Ring (1980) laid

the

foundation for

the

measurement of the depth

of

NDEs, with

the

Weighted Core Experience Index (WCEI). Ring identified

10

of

Moody's

previously

identified components of NDEs but lacked statistical data that would empirically support

near-death

research.

Greyson (1983), attempting to bring legitimacy

to

the scientific investigation of

NDEs, developed the Near-Death Experience Scale, which incorporates statistical

reliability

and validity

in

measuring core components encountered by near-death

experiencers

(NDErs). The final Near-Death Experience Scale comprises 16 items,

further divided

into four

clusters: cognitive,

affective,

paranormal,

and transcendental.

Each cluster was analyzed utilizing inter-item correlations.

Greyson's

sample size

consisted

of

67

individuals

who had reported 74

separate NDEs. Test and

retest

methodologies

were

employed.

Greyson's

(1983) findings revealed that the Near-Death Experience Scale was

highly correlated

with each

of the four clusters,

with

the highest

correlation

found

with

the

transcendental component

(r

= .83). Internal consistency for

scale

had a

Cronbach's

alpha

of

.88. Error variance due to content sampling was determined

by

utilizing split-

half

(odd-even) reliability quotients,

yielding

an r = .84 and

a

Spearman-Brown rho =

.92, indicating

strong correlations

between patients'

NDE accounts. Criterion

validity

of


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19

the

Near-Death

Experience Scale was based on the correlations determined by Greyson

and as compared to those found for Ring's

(1980)

WCEI.

Morris

(1998) interviewed 12 patients

(6

men and 6 women), who had

a

mean age

of 48.1,

with an age

range of 24

to 73 years old.

Morris

utilized Greyson's

(1983)

Near-

Death

Experience

Scale in combination

with

Ring's (1980) WCEI

to

understand the

depth of the

patients'

NDEs.

Morris found that patients reported

similar components

or

experiences as those

reported

in the

Moody

(1975),

Ring

(1980), and Greyson

(1983)

studies. The patients' descriptions of their NDEs were also similar to those reported by

Duffy

and Olsen

(2007).

Lange, Greyson, and

Houran (2004) studied

NDEs, using the Rasch Scale of

Validity, with a sample of 292 (113

males

and 179

females),

with a mean age of 50.8

years. Lange et al. found that those patients who falsely report having NDEs were able to

be singled

out from

those patients who had an actual near-death

experience.

Additionally, findings suggest near-death experiences appear to have

a

basic core of

components previously found by Moody (1975), Greyson (1983),

and

Ring (1980).

Fenwick and Fenwick (2008) found that the differences between

NDEs

and

DBVs

is that an NDE

involves

an actual

event whereby

the experiencer

clinically

dies,

whereas

during

a DBV, the

individual may be near death

but has

not actually experienced clinical

death.

Wills-Brandon (2003b) identified

DBVs as "spiritually

transformative

experiences"

having significant life-changing potential for

patients and families.

Stafford

(2008) explained that DBVs produce

a

sense of comfort for patients and families in their


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20

pointing to

an afterlife.

Composite descriptions

of

DBVs

revealed similar

characteristics

across social, cultural, ethnic, sexual, and

religious

lines.

Life-span Perspectives of Near-Death Experiences

The review of literature contained many anecdotal accounts, from the very

young

to

the very old, of

individuals

who had an NDE. A sample of

their reports,

presented

from the young to the old, is included below.

Pediatric

Population

Morse (1983) reported

an

event whereby

a 7-year-old

girl experienced an

NDE

during

a

freshwater

drowning. The

girl

was

resuscitated, only

after extensive CPR

and

subsequent

intubation, and

was transported

to

the local hospital,

where Morse (an

emergency

room physician) attended to her.

Two weeks

after

the

near-drowning

event,

Morse followed up with the young girl, who presented the following account.

The girl remembered

being

in the water and

knowing that she

was dead. The

next

event that the girl recalled

was that

of traveling through

a

tunnel.

Becoming

frightened,

the girl described a

woman

(Elizabeth) who

came to her. The

girl described

Elizabeth

as

a tall

individual having bright yellow hair.

The

girl said that

Elizabeth

walked her up

to

what was believed

to be Heaven's front

door.

Although not

actually

seeing

past

the door,

the girl reported meeting deceased relatives and adults waiting

to

be reborn.

The

girl

described meeting Jesus, who offered her the option

to

return

to

mortal existence.

Morse, Conner,

and Tyler (1985)

interviewed pediatric

patients

reporting

unusual

events

during the time of

cardiac

arrest.

Below

are abbreviated

accounts

of

their

experiences.


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21

A 6-year-old boy was admitted to

the

hospital for a dual surgical procedure

(tonsillectomy

and adenoidectomy). The boy, while

under

anesthesia,

went

into cardiac

arrest. The boy

had a

clear

recollection of

the NDE

during

the time

of arrest, citing

an

out-of-body experience

in which he

found himself

perched

above, watching

the

resuscitation, then traveling through a multicolored

lit

tunnel,

all

along feeling intense

peace.

An

8-year-old

girl, with

a

history of Graves'

disease,

was

admitted

for

diabetic

ketoacidosis and a hyperosmolar coma. The

girl

arrived

at the

emergency room awake

but

then became

unresponsive

and

comatose

for

over

24 hours. The girl described

three

separate events during the time of the coma. The first event occurred

while

in the

emergency

room.

She described floating

above,

watching the

events

of the resuscitation.

The second

event

involved seeing a teacher and classmates surrounding her, and singing,

wishing

the

girl a fast recovery. The girl, apprehensive when describing

the

third event,

drew pictures describing a frightening NDE.

A

16-year-old

boy,

diagnosed

with chronic

renal failure, was admitted

to

the

hospital

with abdominal and thoracic pain, requiring cardiac bypass surgery.

Complications

arose during

the surgery, resulting in arrest, requiring several minutes of

CPR.

The teenager expressed having traveled to Heaven, describing

the

experience as a

peaceful time,

and talked about walking up

a darkened

staircase

that

had

a

brilliant light

at the top. A deceased brother

told

the teenager

that it

was not yet

time to

die.

Adult

Population

Ernest Hemingway reported having had an NDE while serving with

the

Red Cross

in

Italy.

An exploding

mortal shell resulted in shrapnel being scattered throughout

his


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entire body and

tearing

his

right knee. Recovering in

a

military

hospital,

Hemingway

later

expressed having an out-of-body experience

and

traveling on a spiritual

quest,

describing

his

encounter

as one that

allowed reflection on death

and

dying. Hemingway,

no longer

fearing

death after the

NDE,

felt that dying could be one of the easiest things

to

experience

(Vardamis

& Owens,

1999).

Buddy

Farris, a 26-year-old Virginia State Trooper, experienced a

deep

NDE

Thanksgiving eve night in 1979. Assigned

to

patrol the Interstate

95

corridor from

Richmond, Virginia,

to

Washington,

DC,

Trooper Farris had stopped a speeding

car.

While

he

was standing at

the

back

of

the stopped vehicle,

a

second

car

(driven

by

a

drunk

driver) smashed into the back of the stopped car.

Mr. Farris was declared dead at the

scene

of the

accident and was transported

to

the Richmond morgue

(Appendix

A).

Elderly Population

Ring (1982) reported several

accounts

of

NDEs

among

the elderly.

A 60-year-old

woman who suffered

a

myocardial infarction (heart attack) recalled experiencing total

peace during

her

NDE. A

70-year-old woman, during

a

respiratory arrest, described an

out-of-body experience and seeing

a

tunnel with

a brilliant

light

being

emitted.

Sabom

(1982),

a

cardiologist, conducted research

on

cardiac arrest patients,

finding

many

reporting NDEs.

Two

of his accounts are presented here. A 60-year-old

woman, who was admitted for

severe

back pain, suffered cardiac arrest

and described

watching

the events

of resuscitation

at the

bedside

from above.

A 60-year-old man,

during resuscitation, recalled being outside of his body but then experiencing

a

powerful

force, likened to

a

giant magnet, pull him

back inside the body.


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23

Anecdotal accounts

demonstrate that

NDEs occur more regularly across the

life

span

than

what was

once

thought (Ketzenberger & Keim, 2001). According

to Brayne

et

al.

(2006), near-death

events

have not gained acceptance in medical or social circles

due

to

cultural fears

and taboos.

Anecdotal accounts of DBVs are less reported in the

literature

but

have significant

meaning

for

individuals who

are close

to

death

as well

as

family members who are working

through the

grieving process.

Personal Anecdotes

of

Death

Bed

Visions

Wills-Brandon (2003a) noted

that, as

a teenager, she experienced

a DBV during

the passing

of her mother,

who was hospitalized the last week of

her

life.

The

spiritual

entity that

came to

Wills-Brandon

was

that of her mother in

the

process of

dying.

The next account was

told to

the researcher by the

daughter

and son of

a

patient in

the

Medical Intensive

Care

Unit at a major hospital in

San Antonio, Texas.

The 70-year-

old patient and her children had been told earlier that day by the physician about the

terminal state of

her condition.

They (patient, daughter,

and

son) decided

not to have

artificial

means

instituted to keep her alive but

rather requested that comfort/palliative

measures be administered.

The patient would

awaken

at intervals

and,

for the most part,

was

lucid (Appendix

B).

A south

Texas

college manager of technology

support

shared

the

DBV that her

dying mother experienced (Appendix C).

Attitudes toward Near-Death Experiences

The review of literature revealed

few studies

relevant

to

the knowledge of

NDEs

possessed by healthcare workers or paraprofessionals. Literature was found, however, on


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attitudes toward

NDEs

by other groups, including the clergy, hospital nurses, hospice

nurses,

physicians, and psychologists.

Clergy's Attitudes toward

Near-Death

Experiences

Royse

(1985)

investigated the attitudes of 174 clergy toward

NDEs. A

total of

110

members of the clergy,

who had attended

a death

and

dying class,

served

as

participants.

The

participants

were predominantly male, with

a

mean age of 39 years,

who represented 20 denominations. The results indicated that 13% of

the

participants

reported

having

had

an NDE, and 71% reported having parishioners

who

experienced an

NDE. Additionally, 72% of the participants approved discussing the topic of NDEs with

parishioners.

Hospital Nurses'

Attitudes

toward Near-Death

Experiences

Oakes (1981) interviewed

30

critical care and emergency department nurses in a

major metropolitan health care

facility

in regard to their attitudes toward anecdotal

accounts of

NDEs.

Their

responses

were

mixed, ranging

from

disbelief

of the

existence

of

NDEs to a desire

to

report

the investigator

to the

hospital

administration for

conducting

this type

of interview in

the

hospital. Other

participants

expressed interest in

learning

about near-death experiences (NDEs).

Thornburg (1988) developed a tool with the three subscales of knowledge,

attitude, and caring

for

a patient

who had

experienced an

NDE, to

measure knowledge

and

attitudes

of

nurses toward NDEs. As determined through

a

pilot study, the tool

developed by Thornburg

demonstrated

adequate reliability of the

three

subscales of .83,

.84, and .81, respectively. Content validity was established by experts

in

the disciplines

of sociology, psychology,

and nursing.

The results demonstrated that 95% of


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respondents had heard of NDEs. Attitude

responses

ranged from

fascination

to utter

disdain

and disbelief

as

to how knowing about near-death phenomena

could

help

in the

care of patients.

Using Thornburg's (1988) questionnaire, Cunico (2001) surveyed 750 Italian

nurses and had a 63% response rate. Findings revealed participants reporting personal

NDEs. Compared to other studies that utilized Thornburg's questionnaire, the Italian

nurses did not

have

as much

knowledge

about NDEs,

and

their attitudes

were

less

positive than were those of their Western counterparts.

The findings revealed a desire to

have

professional development

on

the topic

of

NDEs.

Hospice Nurses' Knowledge of and Attitudes toward Near-Death Experiences

Utilizing Thornburg's (1988) questionnaire, Bamett (1990) performed a state

wide study of

Virginia's

hospice nurses, receiving a 54% response rate for

the

111

questionnaires distributed. The results indicated that hospice nurses in Virginia are

knowledgeable about NDEs, with 52% able to correctly answer 12 or

more

of

the

23

knowledge questions. All nurses demonstrated a positive

attitude

about NDEs and

indicated interest

in

learning more about

the

topic

as

a mechanism to

discuss

death and

dying with hospice

clients

and family members (Barnett, 1991).

Physicians' Knowledge

of and Attitudes

toward

Near-Death

Experiences

Barnett (1991) assessed knowledge and attitudes of physicians toward

NDEs.

Although she distributed

1275

questionnaires to physicians, only 143 of

those

returned

were usable. Many more physicians mailed back partially completed surveys (for

reasons not identified) and were not included in the final statistical analysis. The

majority of the participants were male (88%),

with

a Protestant or

Catholic

religious


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affiliation,

and 51%

reported

caring

for clients having

had NDEs.

Additionally, 13%

of

the study participants reported having had an NDE. Most of the physicians exhibited

knowledge

of the

components of

an NDE, and the majority

(65%)

indicated having a

positive attitude toward patients'

NDEs

and

welcomed staff

development's

focusing on

the topic of NDEs, believing NDEs should be

offered

in

a

didactic

curriculum to

healthcare providers

(Moore, 1994).

Psychologists' Attitudes toward Near-Death Experiences

Walker

and

Russell (1989) surveyed 117 psychologists, utilizing Thornburg's

(1988)

questionnaire.

Findings

revealed

high levels

of positive attitudes toward

NDEs.

Additionally, 7% indicated

having

had

an NDE, and 19%

reported having provided

counseling for individuals

expressing

having had

NDEs.

Attitudes toward Death Bed Visions

Fenwick et al.

(2007),

in the

only empirically

driven study found on DBVs,

looked at implications for palliative

care

in relation

to

end-of-life experiences (ELEs).

Based on

interviews

with the

palliative

care

team, DBVs, a

sensation

of

leaving the body,

deathbed coincidences,

hallucinations, and dreams

were

the themes

revealed by

the

participants interviewed.

The

findings revealed that ELEs are frequently reported but that medical

practitioners have

been slow in

acknowledging

the

significance of

these

experiences for

patients and their families. The researchers speculated that

the

lack of recognition of

ELEs might be

related

to

a lack of knowledge about

DBVs on the

part of healthcare

workers.

The results

also

suggested that

ELEs

have

components similar to NDEs and


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27

DBVs. The researchers recommended professional development on near-death

phenomena.

The literature review has shown the need for healthcare professionals and

paraprofessionals to have knowledge and to be accepting of NDEs and DBVs. As such,

these are recommended

topics

for professional development.

Scientific Basis for Near-Death Experiences and Death Bed Visions

A number

of articles

focus on drug-

or

medically-induced states that produced

experiences similar to

NDEs.

Research on various medications and drugs as well

as

medical conditions that

can result

in

NDEs

is presented below.

Ketamine

Jansen

(1997),

who has extensive experience with

the

administration of Ketamine,

a substance used

to produce

altered

states

of

consciousness, reported patient accounts

that

resembled NDEs.

A

sense

of

peace, a common

component

of

NDEs, was

the

only

component not reported by participants who had received

Ketamine.

Ibogaine

Blanchi

(1997)

had

a

different perspective on

the

pharmacological

action of

Ketamine, believing

that it

is

more

of

a

hallucinogen than

a

medication. Blanchi, instead,

examined the role

of

Ibogaine,

an alkaloid

substance extracted from

the

Tabernantle

iboga plant,

native

to

Central

Africa. Blanchi

found

many

tribes

in

Central

Africa,

including the Pygmy, Bakota, and Bakwele

tribes of the

Congo, utilized Ibogaine in ritual

ceremonies involving rites of passage. The tribal leaders believed that ingestion of an

Ibogaine derivative would invoke, in members of

the

tribe, visionary views of

the

meaning of life and death. Blanchi revealed that

the

properties of the Ibogaine plant act


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on

the dopaminergic and

serotonergic

systems

of

the

body, providing

anti-addiction

agents that could

help in the treatment of addiction

to

heroin,

cocaine, amphetamines,

nicotine, and alcohol.

Blanchi found

that individuals

who ingested

Ibogaine derivatives

reported

experiences

similar

to

those reported by

individuals

who had experienced

NDEs.

Dimethyltryptamine

R. Barnett (personal communication, May 29,

2009)

experienced an NDE after

inhaling

Dimethyltryptamine (DMT), a naturally

occurring compound

found in

many

plants

and

animals

(including in the

human

brain), which has

been

used

in certain mystic

tribal

religions to

bring

about vision quests

(Appendix D).

Anoxic States

Blackmore (1998) studied the role

that hypoxia

plays in

triggering NDEs among

children. Blackmore sent 112 questionnaires

to children

who had suffered

cardiac

arrests,

resulting from a condition

known

as

reflex

anoxic seizures

(RAS).

The

results

indicated

that 24%

reported having had some

components

of an

NDE,

including having

an out-of-body experience, being in

a tunnel,

and

seeing

multicolored

lights.

Cardiac Arrests

Schwaninger, Eisenberg, Schechtman, and Weiss (2002) conducted

a

survey of

cardiac

arrest

patients

from April 1991

through

February

1994, following 174 patients

who

had

experienced cardiac arrest, of whom 55 survived

the experience.

Of the 55

individuals,

30 were interviewed, and

7

reported having had

an NDE.

They described

a

feeling of comfort,

peace, and detachment

from the body, with

no report

of pain.

Schwaninger

et

al.

stated

that

NDEs are gaining acceptance in

the

scientific medical


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community

as

important life-changing events

in the lives

of patients and

families

of

patients.

Quantum Biomechanics

Beck and

Colli (2003)

introduced

a

theory of quantum hologram research

providing evidence of instantaneous

empathic

memory recall,

supporting

the occurrence

of life reviews in patients having had NDEs. The researchers investigated

the

relationship of the microscopic neuro-microtubules found in the

brain,

which create

a

person's memories. The

researchers believe that neuro-microtubules are

key components

of

human

consciousness,

providing

a link to unlimited memory

storage capacity

within

the

human

DNA.

As such, these neuro-microtubules provide an explanatory

mechanism

for

the life-review process seen in NDEs.

Philosophical

and

Theological Meanings

of

Near-Death

Experiences and Death Bed Visions

Moody (2007)

discussed

the connection between NDEs

and ancient

Greek

philosophy. Moody noted that,

while

attempting

to

gain knowledge

of

the afterlife,

ancient

Greek philosophers would isolate themselves, venturing into otherworld

environments. The

philosophers,

evoking spirits of the dead, would have out-of-body

experiences. The

culmination

of the early

philosophers'

ventures resulted in uncovering

nine

concepts relevant

to

understanding the meaning of life

after

death and that still have

an influence

today.

Unimaginable

phenomenal

experiences

Relationship between mind and

body

Spiritual visions of deceased individuals


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30

Reincarnation

of souls of

the

dead

Past mortal behavior determines future spiritual existence

Curiosity of spiritual existence after

a

loved one's death

Empathy

for those

dying and

those

who are grieving

Life after death construed as non-literal dimensions of the meaning that supports

those

concepts and components

experienced

by those who

have

a

close brush

with

death

The

afterlife as

the final great mystery

Bain (1999) explored

the parallels between Gnostic Christianity

and NDEs,

supporting

previous

research showing similarities between what near-death experiencers

report and what has been expressed in religion.

Bain's findings support

previous

research

showing similarities between what near-death experiencers report

and

what

has

been

expressed in religion

chronicles, including

the Holy Bible; the

Tibetan Book

of

the Dead;

the Koran; the Hindu Upanishads; and Egyptian, Zoroastrian, and Babylonian scrolls.

The Bible

contains

a

description of another place that one

goes to

as death ensues:

These all died in faith, not having received

the

promises,

but

having

seen them

afar off, and were persuaded of them, and embraced them, and confessed that they

were strangers and pilgrims

on

the

earth.

For they

that say such

things

declare

plainly that

they

seek

a

country. And

truly,

if they had been mindful of that

country

from whence

they

came out,

they might have had opportunity

to have

returned.

But

now

they desire

a

better

country,

that is, heavenly: wherefore God

is

not ashamed to

be

called

their God:

for

he hath prepared

for them

a city

(Hebrews

11: 13-16).


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31

In another passage of the Bible, individuals on

the

brink of death express

indescribable knowledge (a component

of

the NDE) as follows:

I know a man in Christ who fourteen years ago was caught up to

the

third heaven.

Whether

it

was

in the

body

or out

of

the

body I

do

not knowGod knows.

And

I

know that

the

manwhether in

the

body or apart from

the

body I do not know,

but God knowswas

caught

up to paradise.

He heard inexpressible things, things

that man is not permitted to tell (2 Corinthians 12:2-4).

Based on biblical scriptures, the Christian faith believes in an afterlife, supporting the

construct of

what

occurs

with NDEs

and DBVs.

Murphy (2001) found similarities of NDEs

with the

experiences

of

Buddhists who

have experienced a brush with death. One of

the most

striking similarities relates to

the

out-of-body experience and the meeting of a supreme spiritual being. In

the

context of

the

Buddhist religion, the supreme spiritual guide identified as Yama is

the

entity who

escorts

those

who are worthy to meet

the

Lord Buddha.

Green (1998) studied the similarities found between aspects of shamanistic

journeys and spiritual out-of-body experiences occurring with NDEs. The researchers

described shamanic journeys in

which the

individual passes into an altered

state

of

awareness

and

experiences out-of-body events.

The

belief

held by

practicing Shamanists

is

that, through

the

out-of-body experience,

one

goes on a

vast

journey through other

dimensional worlds, populated

by

the

spiritual dead. During

the

journey,

the

shaman

experiencer forms relationships with spiritual beings, learning how to help individuals in

the

mortal world to have more spiritually enriched lives.


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32

Slattery

(2009) examined

the

spiritual life-force found within

all

individuals.

Slattery

attempted

to uncover the

meaning

of

consciousness. Slattery studied Native

Indian beliefs and

compared

rituals from Eastern mystic religions and Western science

that pointed

to a

physical and

a

spiritual realm of existence.

Flew (2007),

a

passionate atheist for most of his life, became

a

believer in

God

in

the last six years

of

his

life

(Sadly, he

died

April 8, 2010, one day prior to this

dissertation proposal

defense).

Flew stated:

What

I

think the

DNA

material has done is that it has

shown,

by the

almost

unbelievable complexity of the arrangements which

are needed to

produce

(life),

that intelligence must have been involved

in

getting

these

extraordinarily diverse

elements

to

work together.

It's the

enormous

complexity of the number of

elements

and the

enormous

subtlety of the ways they work together. The meeting

of

these two

parts at

the

right time

by chance

is

simply minute . . . which

looks to

me like the work of intelligence

(p.

75).

Understanding and accepting the religious and spiritual beliefs of

others

can

assist

in the provision of culturally competent and

holistic

care. Abrums (2000) noted that

nurses

can

become uncomfortable addressing

the

spiritual

needs

of

families

and patients

during times

of

death. This may

be

because nurses lack

certain

spiritual

carative

skills to

provide empathy

to

patients who experience NDEs and DBVs.

Abrums (2000) conducted

an

ethnographic analysis, based on interviews, of

members of

a

small African American

church

to explore the meaning of death and

grieving. Abrums found that the study participants had particular ways of managing

death, whether

the death was

that

of

an adult or

child. Participants

had strong

beliefs

in


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the afterlife, and during times of death, the church members would come together in

praise of

the dying one's

life,

while

supporting

his

or

her

journey forward

to

the next life

and

supports a

previous account reported (C.

Perkins,

2009,

Appendix

C).

The

findings

indicated that religious African

Americans

routinely employ ways to

support

one

another

during the death process, providing holistic

care and support to individuals

experiencing

NDEs and

DBVs.

Summary

The

review of literature has provided a

summary

of quantitative and qualitative

research in

the field of NDEs

and DBVs.

Greyson

(2006) noted

the

importance of

understanding

NDEs and related phenomena

such

as

DBVs not only

from a

philosophical

perspective but also

in terms

of

the care provided

by healthcare professionals, stating that

NDEs and DBVs are life-changing

experiences with

significant

meaning

in the lives of

patients

and

families.

In

this

regard, Cole

(1993) stated:

It

appears

important

to

demonstrate

the

profound psychological impact

such an

experience has on any individual, and to find out just how the doctors and nurses

are

dealing with such

patients and

what aspects of

nursing

care

could

be

improved

(p. 157).

Our responsibility as healthcare

professionals

is

to

ensure that

the

care that is

provided is both transforming and transcendental. The care also should support

a

comprehensive, culturally-competent

holistic

philosophy of

care

for all who become

sick

and

who

are on the

brink

of

death. The philosophy of care should be seen throughout the

hospital experience

and

when

a patient

is discharged

to

home

health and/or

hospice

care

services and should incorporate the treatment of

family

members

(Quill,

1999).


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34

CHAPTER 3

METHODOLOGY

Introduction

The purpose of the study was to

assess

knowledge, attitudes, and views of nursing

faculty

towards patients

with perceived near-death experiences and death

bed

visions.

The secondary purpose was to explore perceptions

of nursing

faculty toward patients with

near-death visions

and

death bed visions. The following research questions were

investigated:

1. What do nursing faculty know about near-death experiences?

2. What are

the

attitudes of nursing faculty

toward

near-death experiences?

3. What

are

the perceptions of nursing faculty regarding near-death experiences?

4. What are the perceptions of nursing faculty regarding death bed visions?

Research Design

The study used

a

mixed-methods approach, utilizing both quantitative and

qualitative data drawn

from

an electronic questionnaire. The quantitative aspect provided

data

that were

measurable and amenable to analysis,

lending breadth

to

the study.

The

qualitative data, from

responses to

open-ended questions, provided rich,

detailed accounts

of reports of NDE and DBV experiences of patients, family, or others, lending depth to

the study (Creswell, Clark, Gutman & Hanson, 2003).

A triangulation-convergence approach to

data integration and analysis

was

used

for interpretation. The study triangulated findings from the quantitative and qualitative

portions

as a

means to develop valid and well-substantiated conclusions

about

nursing

faculty's

knowledge or and attitudes toward near-death phenomena (Creswell, 2005).


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35

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