BEREAVEMENT IN THE ABRAHAMIC FAITHS - eTheses Repository

410 Pages·2010·2.15 MB·English

by  Dawn Alison Chaplin

A STUDY OF BEREAVEMENT IN THE ABRAHAMIC FAITHS

by
DAWN ALISON CHAPLIN

A thesis submitted to
The University of Birmingham
for the degree of
DOCTOR OF PHILOSOPHY

School of Health Sciences
The University of Birmingham
March 2009
University of Birmingham Research Archive

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ABSTRACT

In the UK approximately 60% of deaths occur in acute hospital settings to people
from different cultures and religions. This thesis explored the experiences of
bereaved relatives from the Christian, Jewish and Muslim faiths, doctors, nurses,
healthcare assistants and religious leaders to explore the essences of
bereavement and implications for providing religiously appropriate end of life and
bereavement care in an acute hospital setting. Phenomenology provided the
philosophical and intellectual framework and van Manen’s (1984) four existential
dimensions of temporality, spatiality, corporeality, and communality the structure.

Chronological story telling allowed exploration of the ‘lived’ experience of
bereavement and demonstrated that current bereavement theories and practice
are not always reflective of the diverse needs of a multifaith and multicultural
population. Similarities and differences in the requirements of the 3 Abrahamic
faiths became apparent through the experiences of all participants and the
importance and significance of doing the right thing, at the right time for the right
person in a sensitive and caring way was demonstrated. The impact of end of life
care on the bereavement experience was palpable throughout participant
recollections.

The study highlighted education and training needs not only of hospital staff but of
the general public and the need for a more holistic approach to bereavement
theory, policy, practice and research.
This thesis is dedicated to my dear sister Helen,
always in my heart
The Heavy Stone

My grief was a heavy stone
rough and sharp.
Grasping to pick it up
my hands were cut

Afraid to let it go
I carried it.
While I had my grief
you were not lost

The rain of my tears
smoothed it.
The wind of my rage
weathered it,
making it round and small.

The cuts in my hand have healed.
Now in my palm it rests,
sometimes almost beautiful,
sometimes almost you.

Anon
FORWARD

Throughout my work experiences and, more recently, my position as Head of
Bereavement Care in a large acute NHS teaching hospital trust, I have identified
areas of need within end of life care, especially from a religious perspective which
have caused concern, distress and have had a direct impact on the bereavement
experience of those left behind. This has often been related to situations where
staff were unfamiliar with the religious requirements of patients and their families
at this final stage of mortal life.

In the course of my work, I have had discussions with thousands of bereaved
people. I have gained anecdotal evidence about the experiences of these
individuals and their needs as their loved ones were dying, and during their
ensuing bereavement. As a nurse, I have had professional experience of end of
life situations and have had many discussions with doctors, nurses and healthcare
assistants about their experiences in this sensitive and often difficult area and its
impact for them personally and professionally. I have also been privileged to work
alongside faith leaders from the world’s major religions and this has helped me to
understand what is important to these different groups at such times and why.

Personally of much greater importance and significance, was the sudden death of
my dear sister Helen during the writing up stage of this thesis. This has impacted
upon my personal perspective of bereavement moving me from an objective
position of providing care for others in their bereavement to a subjective position of
being the cared for ‘’bereaved’’. This has further heightened my sensitivity and
reinforced my need to understand more about what the real essence of
bereavement is to the individual and to understand what dying, death and
bereavement means in differing religious contexts. It is hoped that my ongoing
search for understanding can be of use to others seeking to understand what
bereavement means to them following the death of a loved one; and to enlighten
those involved in the provision of care at such times.
ACKNOWLEDGEMENTS

Firstly, I would like to thank my supervisor Professor Collette Clifford for her
encouragement, guidance and patience. It has been a difficult journey and she has
helped and supported me in the most sensitive and caring way possible
throughout.

My thanks also go to my colleagues in the Bereavement Care Service at
University Hospital Birmingham NHS Foundation Trust (UHBFT) for their unfailing
loyalty, caring and support.

I will always feel honoured and privileged to have heard each participant’s story
and I thank each and everyone for their honesty and openness.

My grateful thanks go to both The Wellcome Clinical Research facility and the
senior nursing team at UHBFT for their funding and recognition of the worth of
postgraduate research study for nurses and especially in bereavement care.

Tracy Dudley provided support and assistance with the data for which I am
grateful. Anita Pye provided selfless help and support with the assembly and
presentation of this thesis and I will always be in her debt.

A big thank you to all my friends for their patience and for always believing in me.
Finally, to my Mum, Dad, two nephews Tom and Alex, dear sister Helen and my
darling Sue, thank you for being there and for your unconditional love.
TABLE OF CONTENTS

LIST OF TABLES

CHAPTER 1............................................................................................................1
INTRODUCTION AND BACKGROUND .................................................................1
1.1 Concept and theories of bereavement.......................................................2
1.1.1 Death and bereavement: a historical perspective..............................4
1.1.2 Overview of bereavement theory.......................................................6
1.2 Religion and bereavement.......................................................................13
1.2.1 Spirituality and religion.....................................................................13
1.2.2 Religious and cultural aspects of bereavement...............................14
1.2.3 Religious perspectives of the Abrahamic faiths...............................16
1.2.4 Cultural and religious end of life perspectives .................................24
1.3 Influencing factors on the bereavement experience................................28
1.3.1 Environment (Space) home versus hospital....................................28
1.3.2. Perception of death ‘good’ or ‘bad’ – The individual ‘lived experience’
.........................................................................................................31
1.3.3 Individual perspectives of bereavement...........................................33
1.4 Healthcare provision and its relevance at end of life and bereavement
care..........................................................................................................37
1.4.1 The Bereavement Care Service at a large hospital Trust in the West
Midlands..........................................................................................40
1.5 Conclusion...............................................................................................42
1.5.1 Aims and objectives of the study.....................................................44

CHAPTER 2..........................................................................................................46
CONTEXT OF STUDY..........................................................................................46
2.1 Phenomenology.......................................................................................47
2.1.1 Bereavement as a phenomenon......................................................48
2.1.2 Origins of phenomenology...............................................................49
2.1.3 The History of phenomenology and key phenomenological
philosophers....................................................................................51
2.2 Phenomenological application.................................................................55
2.2.1. A. Turning to the Nature of lived experience....................................58
2.2.1 B. Existential Investigation...............................................................60
2.2.1 C. Phenomenological Reflection......................................................66
2.2.1 D. Phenomenological writing...........................................................69
2.3 Conclusion...............................................................................................72

CHAPTER 3..........................................................................................................73
RESEARCH DESIGN AND METHODOLOGY......................................................73
3.1 Who participates in bereavement research?............................................74
3.2 Research design for the studies undertaken in this thesis.......................79
3.2.1 Identifying participants.....................................................................81
3.2.2 Collecting the data...........................................................................89
3.2.3 Conducting the interviews...............................................................94
3.2.4 Confidentiality.................................................................................98
3.2.5 Data recording and transcript ........................................................100
3.2.6 Data analysis................................................................................101
3.3 Results presentation..............................................................................105
3.4 Conclusion.............................................................................................106

CHAPTER 4........................................................................................................108
RESULTS: THE EXISTENTIAL DIMENSION OF TIME......................................108
4.1 A time to live..........................................................................................111
4.2 A time to die...........................................................................................113
4.3 The Time of Death.................................................................................123
4.4 After death.............................................................................................130
4.5 Eternity ..................................................................................................133
4.6 Summary...............................................................................................136

CHAPTER 5........................................................................................................140
RESULTS: THE EXISTENTIAL DIMENSION OF SPACE..................................140
5.1 Environment...........................................................................................142
5.2 Place of death........................................................................................146
5.3 Space at time of death...........................................................................147
5.4 The final resting place (memories and reminders).................................152
5.5 Heaven and Hell....................................................................................156
5.6 Summary...............................................................................................160

CHAPTER 6........................................................................................................163
RESULTS: THE EXISTENTIAL DIMENSION OF THE LIVED BODY.................163
6.1 Moving towards death............................................................................165
6.2 Emotional manifestations of bereavement.............................................172
6.3 Last care and its implications.................................................................174
6.4 Moving on, looking back........................................................................183
6.5 Good death / bad death.........................................................................187
6.6 Summary...............................................................................................191

CHAPTER 7........................................................................................................195
RESULTS: THE EXISTENTIAL DIMENSION OF RELATIONSHIPS..................195
7.1 The intertwining of relationships along the bereavement journey..........198
7.2 Shades of truth and white lies................................................................204
7.3 Relationships across the divide.............................................................210
7.4 Imprint of bereavement..........................................................................220
7.5 Bereavement counselling / support........................................................229
7.6 Education and training...........................................................................231
7.7 Summary...............................................................................................233

CHAPTER 8........................................................................................................239
DISCUSSION......................................................................................................239

CHAPTER 9........................................................................................................306
CONCLUSION AND FURTHER CONSIDERATIONS ........................................306
BIBLIOGRAPHY.................................................................................................314
APPENDICES

A: ANALYSIS OF FIRST LETTERS OF COMPLAINT FOLLOWING THE DEATH
OF A PATIENT
B: HELEN - A PERSONAL STORY

C: INFORMATION PACK FOR RELATIVE PARTICIPANTS

D: INFORMATION PACK FOR HEALTHCARE PROFESSIONALS

E: INFORMATION PACK FOR RELIGIOUS LEADERS

F: INTERVIEW SCHEDULE

G: A WORKED EXAMPLE OF DATA ANALYSIS FOR EACH OF THE FOUR
EXISTENTIAL DIMENSIONS (TIME, SPACE, BODY AND RELATIONSHIPS)

H: PUBLICATIONS AND PRESENTATIONS AS A PRECURSOR TO, OR
ARISING FROM, THE STUDY IN THE THESIS