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The purpose of this study is to explore and classify the types of the attitude on a good death of nurses in long-term care hospitals. Q-methodology, which is effective in scientifically measuring individual subjectivity, was used. 151 Q-population were selected through the processes of review of research articles, newspaper articles and interviews. 34 Q-sample were selected from the 151 Q-population and 27 nurses in long-term care hospitals were invited as the P sample. The result of the Q-sort was analyzed using PC QUANL Program. The types of attitude on a good death of nurses in long-term care hospitals was categorized into three. 1) Death in supportive environment 2) a comfortable death in real life 3) Dignity guaranteed death By identifying 3 attitude patterns toward a good death of long-term hospital nurses, this study provides an opportunity for their reflection and recognition toward a good death based on this result and suggests to think about ways to improve the quality of nursing in the current increasing long-term hospitals.

This study has been performed to identify meanings of good deaths among 350 old people aged 65 from September, 2010 until February, 2011. In this study, the subjects were asked about good meanings of death based on qualitative study of free format, and their statements were categorized into similar content areas. The results show that first, the subjects felt that the good death is a dignity death not weighing burdens to others, memorized as a good life, until th end of my life, a death receiving at home, comfortable death, a death like a sleep, with out pain, not long, a prepared process, a death after doing my best, receiving after doing my best, death after offering benevolence to others, within my beliefs, and finally a good death is after seeing good life of my descendent. These 16 free answers were also categorized into 6 meaningful areas such as considering others, at my home, comfortable scene, prepared, and death after living my wanted time.

Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy to recognise and distinguish from other respiratory patterns and, in the dying patient who has elected to not be resuscitated, will always result in terminal apnoea. Gasping respiration is also referred to as agonal respiration and the name is appropriate because the gasping breaths appear uncomfortable and raise concern that the patient is suffering and in agony. Enough uncertainty exists about the influence of gasping respiration on patient wellbeing, that it is appropriate to assume that the gasping breaths are burdensome to patients. Therefore, gasping respiration at the end of life should be treated. We propose that there is an ethical basis, in rare circumstances, for the use of neuromuscular blockade to suppress prolonged episodes of agonal respiration in the well-sedated patient in order to allow a peaceful and comfortable death.

EDITOR—Haas's observation that few junior doctors witness peaceful expected death mirrors my own experience in a district general hospital.1 I am frequently involved in both suggesting and confirming that a patient is dying and then advising on suitable care and drug treatment to achieve a comfortable death. I always encourage junior doctors to spend time with a patient they say they can do no more for. A daily contact that shows genuine concern for the patient, …

Purpose: The purpose of this study was to further understanding of the experience in acceptance of hospice by patients with terminal cancer and to explore the structure of this experience. Methods: A phenomenological methodology was used for the study. Participants were nine patients who were admitted to the hospice unit of a university hospital. In-depth interviews were done for data collection and the data were analyzed using Colaizzi"s method. Results: Four categories, eight theme clusters and 18 themes were identified for the experience in acceptance of hospice by patients with terminal cancer. The three categories were ‘Hope for a comfortable death’, ‘Overcoming barrier of prejudice about hospice’, ‘Incessant craving for life’, ‘The last consideration for self and family’ Conclusion: While accepting the hospice care, participants experienced inner conflict between giving up medical treatments that prolong life and choosing a comfortable death, and also experienced an incessant craving for life. By accepting hospice care, they showed a human dignity that entails careful concerns for both self and family members.

American physicians refer patients to hospice too late. Christakis and Lamont's research shows that physicians are poor prognosticians and tend to overestimate how long a person who is terminally ill will live. Most of the patients (65%) in their study had cancer. This is similar to the proportion (60%) found in hospice patients in a survey carried out in 1995, despite that cancer is not the leading cause of death in the United States.1 Seven percent of the patients referred to these hospices died within hours of admission. This 11th-hour referral pattern is at least partly due to physicians not recognizing the nearness of death. A patient is eligible for hospice care if he or she has an estimated life expectancy of 6 months or less. As the authors point out, the actual length of stay is usually less than 6 weeks. Thus, most patients come to hospice during a period of rapid physical change and often in crisis. And they don't live long beyond the crisis. At times of crisis, the immediate management of symptoms and relieving the family overshadow the need to address the emotional and spiritual issues of remembering, forgiving, and bringing to closure the issues of a person's life. Providing a physically comfortable death is a worthy goal; it reduces regrets among survivors. Yet, more time provides the opportunity for the dying person to participate directly in the process of validating the past and planning for the future and gives the family the chance to relish or repair bonds with the dying person. The National Hospice Organization has tried to educate physicians about how to predict appropriate entry points to hospice for various conditions.2 These guidelines should be incorporated into the general education of physicians. The authors' suggestion that prognostication should be done by a “disinterested” experienced physician hits near a common thread of late hospice referrals. Physicians may be reluctant to acknowledge that patients they know well are close to death. This can be compounded by a patient's and family's preference to keep hoping for the patient to live longer. Those of us who know our patients longer often become attached to them. We, too, hate to admit that death is near. I remember a woman in her 60s I was treating for metastatic breast cancer. She was admitted to the hospital with gastric bleeding that was thought to be unrelated to her cancer. I talked to her and her husband and was optimistic about the reversibility of the problem. Because I was trying not to scare her, I did not discuss the issues of advanced directives and resuscitation. That night, she went into shock, required intubation, and went to the intensive care unit. Her husband was devastated and angry that she had had such treatment. The next day, he and I together decided that no additional treatment would be given to prevent her death. He sat with her for more than 24 hours before she died. My desire to be optimistic prolonged her dying and added anguish to her husband. Physicians often rail against the denial of patients and their families. Yet, we are not immune. Decisions at the end of life are not just guided by physicians. There is a complex interaction when a physician recognizes and acts on an accurate prognostication, what the physician tells the patient and family, and what the patient and family actually hear. Christakis and Lamont have begun to tease out the factors involved in end-of-life predictions. In oncology, the end of chemotherapy usually signals the terminal phase. In other specialties, prognosis is much less demarcated. Physicians should better define landmarks or turning points in prognosis and begin to acknowledge these to themselves and their patients. Only then can physicians adequately guide patients through the dying process.

Cancer-related pain can be well controlled in most patients. With prolonged survival and cure now possible with many tumors, pain management becomes a compelling issue for the quality of the patient's remaining life. In advanced stages of disease, analgesia is an imperative for both the patient and family; it provides the patient the opportunity for a dignified and comfortable death and lifts from the family the added burden of anger and despair that is so often associated with uncontrolled pain in a loved one. Astute assessment, a systematic approach to pharmacologic treatment, and ongoing monitoring of therapy are the fundamental elements of successful management of pain in most patients.