Academic journal article Research and Theory for Nursing Practice

Death Anxiety: An Analysis of an Evolving Concept

Academic journal article Research and Theory for Nursing Practice

Death Anxiety: An Analysis of an Evolving Concept

Article excerpt

This article identifies defining attributes, antecedents, and consequences of the concept of death anxiety using Rodgers (2000) evolutionary method of concept analysis. The literature on death anxiety was systematically reviewed for the years 1980-2007. Articles were summarized and coded. Inductive data analyses resulted in defining attributes (emotion, cognitive, experiential, developmental, sociocultural shaping, and source of motivation), antecedents (stressful environments and the experience of unpredictable circumstances, diagnosis of a life-threatening illness or the experience of a life-threatening event, and experiences with death and dying), and consequences (adaptive and maladaptive presentations). Results are important because little systematic inquiry of death anxiety exists in nursing literature.

Keywords: death anxiety; death; nursing; concept analysis

Death-unto itself-Exception-Is exempt from Change

- Emily Dickinson

Death is a powerful human concern that has been conceptualized as a powerful motivating force behind much creative expression and philosophic inquiry throughout the ages. Leo Tolstoy, renowned 19th-century Russian moral thinker and novelist, aptly illustrated the human challenges in confronting the inevitability of death and the anxiety it provokes as he vividly describes the last three days of Ivan Ilych's egocentric, seemingly meaningless existence in "The Death of Ivan Ilych." Included in this tale is a depiction of death as a metaphorical private black sack that the anguished Ivan Ilych struggled against but was driven toward by an imperceptible, resistless power (Tolstoy, 1960).

"Death anxiety" is a term used to conceptualize the apprehension generated by death awareness (Abdel-Khalek, 2005). Humans are unique in that they must learn to live and adapt to the consciousness of their own finiteness (Becker, 1973). Thus, a major task for cultural systems is to provide a symbolic structure that addresses death and provides meaning for its occurrence and a context for its transcendence (Becker 1973; Kübler-Ross, 2002). Confronting death and the anxiety generated by knowledge of its inevitability is a universal psychological quandary for humans. For health care providers, death is an ever-present reality despite increasing technologically advanced health systems, longer patient survival, and cure from life- threatening conditions. Although helping individuals and their families manage death is a central responsibility of nursing worldwide and an increasing literature suggests that death anxiety contributes to important emotional and behavioral outcomes, theoretical and empirical background of the concept has not been systematically examined in the nursing literature. This limitation has led to a dearth of literature that has explored death anxiety as an important variable in empirical nursing inquiry, a finding that may compromise the development of interventions to assist nursing personnel and the myriad of patients affected in their ability to cope with this profound existential issue. To date, few efforts have been directed toward clarification of this critical concept in nursing (Nyatanga & de Vocht, 2006), although death anxiety is included as a nursing diagnosis with NANDA nursing outcome criteria (Carpenito-Moyet, 2008; Moorhead, Johnson, Maas, & Swanson, 2008).

Nyantanga and de Vocht (2006) argue that a clear and comprehensive theoretical definition of the death anxiety concept that integrates the divergent theoretical approaches is not found in the nursing literature despite its critical relevance to palliative care practice and research. Yet death anxiety is an important concept to consider in a wide range of practice settings, including community cancer screenings of healthy individuals, psychiatric care, acute and trauma care, chronic care, and pediatrics and in individuals facing diagnosis of a life-threatening illness. The goal of this article is to help move nursing science forward by identifying important defining attributes, antecedents, and consequences of the concept and to provide a synopsis of this work for nursing utilization and practice. …

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