Attitudes of Terminally Ill Patients toward Death and Dying in Nigeria.

The purpose of this study was to analyze the attitudes of terminally ill patients toward death and dying. Four hospitals in Nigeria were randomly selected: University College Hospital, Ibadan; University of Benin Teaching Hospital, Benin City; the Lagos University Teaching Hospital, Lagos; and Igbinedion Specialist Hospital, Okada, Benin City. Sixty, terminally ill patients participated in a structured interview within a descriptive design. Chi-square frequency analysis indicated that the attitudes of the terminally ill toward death and dying were significantly negative. Death is an issue all humans must face. All human beings can testify that there is birth, that humans progress through various developmental stages of maturity, and that the stages of life end at death. However, there is nobody that can say at what point they came into being and at what point they were deceased. As life moves on, humans live in hopes of seeing the next day. When life ends, it is celebrated in most societies. Death is normally marked by an atmosphere of sorrow by immediate family members and loved ones. However, when the deceased is an older person, there is often some sort of joy and ceremony, the type of which depends on that person's culture and tradition. In celebrating the life of the deceased, the following play a prominent role: religion, culture, money available, and the contribution to the society or community in which they belong In medieval times, people in the Western World approached death in a more natural way than in present day. Technology has separated westerners from the fundamentals of their biological existence, which has resulted in the realities of death being obscured (Foos—Graber 1989). Reliantly, people think about death and fear it more today with the emergence of HIV/AIDS. However, many people witness death through the television only, as many have no real experience dealing with the death of close relatives or loved ones. So, when it happens people just do not know how to deal with it. Kubler — Ross (1969) described five stages of grief. These five stages have been very useful to understand people's reactions to grief in general, and dying in particular. They are: denial, anger, bargaining, depression, and acceptance. She explained that these are normal reactions we have to tragic events. These stages have also been referred to as a defense mechanism or coping mechanism when applied to dealing with traumatic change. Humans do not move through the stages one at a time, in a neat, linear, step-bystep manner. People merely occupy different stages at different times and can even move back to stages they have been in before. The stages can last for different periods of time and will replace each other or exist at times concurrently. Ideally it would be nice to think that humans could all reach the stage of acceptance, which enables persons to cope with tragedy. Despite the fact that the phenomenon of death is inevitable and is a common occurrence within any society, it is human nature that nobody wants to die. In Nigeria, death and dying are not issues commonly talked about in families, probably because of the fear and mystery surrounding it (Olokor, 1998). Many people do not experience the death of a loved one until middle age and many people die away from the home (e.g. hospices or hospitals) and therefore it is not part of the everyday life of family and friends. People previously always died at home so there was a lot of acceptance of death and you saw death. Although philosophical in nature, the practical concept of death and dying can fall within the realm of health education, in which intellectual, psychological, and social dimensions relate to activities that increase the ability of people to make informed decisions about their personal, family, and community well-being (Ross & Mico, 1980). Today's terminally-ill patient is progressively losing the privilege of dying in familiar surroundings — surrounded by family, with the patient as the center of interest, and in control of their environment (Olokor, 1998). Furthermore, the prolongation and termination of life is receiving attention by health educators, scientists, social scientists, legal scholars, mass media practitioners, policy makers, and the informed public. Some of these interests naturally stem from the fact that dying is a common human experience. Interest intensifies with age, as people begin to perceive themselves in a race against time. Individuals charged with the care of terminal patients, and those engaged in the development of social policies on health at local and national levels, are faced with many issues, such as funding, facilities, medications, and life-support mechanisms. It is the attitudes of a society that greatly influence the attitudes of the terminally ill toward impending death (Olokor, 1998), and it is the culture of a people that greatly determines their attitudes toward death and dying. Typically, the terminally ill hold a personal hope of overcoming their diseased state, and personal efforts are made to maintain life (e.g., strictly following all instructions given by doctors, taking medication). The attitude of registered nurses (RNs) toward death and dying patients may influence the care they are able to provide (Rooda, Clement & Jordon 1999). The implementation of an educational program tailored to oncology nurses' needs may be useful in helping to foster more positive attitudes toward death and dying patients, therefore providing quality end-of-life (EOL) care. Lange, Thom, and Kline (2008) opined that less experienced oncology nurses will most likely benefit from increased education, training and exposure to effectively handle end-of-life care. Feudtner et al. (2007) reported that nurses with more years of nursing practice, more hours of palliative care education, and higher levels of hope were more comfortable providing care to dying children and their families, had less difficulty talking about death and dying and showed increased levels of palliative care competency. However, the culture, values, customs, and socio-cultural Attitudes of Terminally Ill Patients toward Death and Dying in Nigeria