Vol. 8 Issue 11
The Learning Scope
Nurses are the key to recognizing and supporting patients who have them
This offering expires in 2 years: April 24, 2008
The goal of this continuing education article is to provide nurses with current information on near-death experiences (NDEs). After reading this article, you will be able to:
1. Describe an NDE.
2. Identify three characteristics and aftereffects of the NDE.
3. Discuss three possible interventions for the plan of care.
You can earn 1 contact hour of continuing education credit in three ways: 1) For immediate results and certificate, go to www.advanceweb.com/nurses. Grade and certificate are available immediately after taking the online test. 2) Send the answer sheet (or a photocopy) to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the answer sheet to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.
Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 011-3-H-04), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Merion Publications Inc. also is approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).
People who come close to death or encounter a temporary state of clinical or emotional crisis often report having exceptional experiences, called near-death experiences (NDEs). People who have NDEs describe them as some of the most emotional and powerful events of their lives. The NDE changes their beliefs, values and some physiological parameters forever. NDEs happen across cultures age, gender, race, religion and social standing do not seem to influence the occurrence of the NDE. No one really knows why some people have experiences and others don't.
For example, in his book Return From Tomorrow, George Ritchie describes himself as a bad boy who was about to go to basic training in the Army. However, after a serious illness and a profound NDE, his life changed forever. He was not a religious man and had no real ambitions in medicine. The future doctor's NDE altered his entire perspective on life, and radically changed his behaviors and ambitions.
According to the latest (1997) poll used in the U.S. and cited by U.S. News & World Report, there are an estimated 15 million people who have NDEs (or 5 percent of the population) in the U.S. In Europe, the estimate is 4 percent. However, a concern with this poll is that it excludes children and elderly populations. Nonetheless, it confirms a large number of people have NDEs with implications for healthcare providers.
The NDE does not fit into our usual understanding of patient experiences and can be very difficult for patients to understand, and even more difficult to explain to families and healthcare providers. Patients may be very emotional and find it difficult to tell others about their NDEs. According to major research studies, as many as 30 percent of patients who have been clinically compromised or come close to death may report having NDEs. The largest proportions of these patients are typically found in the ED, ICU, CCU, OR, NICU, labor and delivery, and peds units; however, they may be found anywhere in the hospital.
NDEs are intense, emotional experiences that occur when a person is close to death or in a clinical compromise such as an accident, illness, combat, surgery or emotional trauma, and then goes on to have one or more of the common characteristics of the NDE.
Unfortunately, many times these patients may be labeled confused. Children may be accused of making things up or dreaming. However, NDEs do differ from other states of consciousness such as hallucinations, hypoxic states, endorphin or drug reactions, dreams and/or depersonalization. The NDE is different from other states of consciousness.
The first research on NDEs was conducted by Raymond Moody and published in Life After Life in 1975. He described his observations of experiences with heart patients, and it was in this study and book that he coined the expression near-death experience. Kenneth Ring, one of the foremost NDE researchers, wrote several books in the mid-1980s using scientific techniques to describe NDE. In 1995, Peter Fenwick, a neuropsychiatrist, and Elizabeth Fenwick conducted a study and published the results of more than 300 NDEs in the United Kingdom. Currently, Pim van Lommel is leading a critical study in the Netherlands.
Bruce Greyson's work has been central to understanding the NDE and separating it from mental health issues or other experiences. A physician and professor at the University of Virginia, he has researched and written on NDEs for 30 years. Greyson developed the Greyson Scale, the first scale for quantifying individual NDEs. In 2000, he published a chapter in the American Psychological Association book Varieties of Anomalous Experience: Examining the Scientific Evidence, which was the association's first formal acknowledgment of non-ordinary experiences. Greyson's scale captures many of the NDE characteristics listed below.
NDEs in adults tend to be characterized by one or more characteristics. The following is a partial list:
• sensing inexpressible peace, comfort and unconditional love;
• feeling relief from pain;
• separating from the physical body, a feeling of floating;
• seeing and/or sensing a superior being;
• seeing beautiful scenery, hearing beautiful music;
• seeing and communicating with spiritual beings (often deceased loved ones or unfamiliar relatives);
• moving through a dark space or tunnel;
• being surrounded by a brilliant light and/or unfamiliar colors;
• possessing unlimited knowledge;
• communicating telepathically;
• experiencing life review; and
• coming to a physical boundary.
Circumstances of NDE
NDEs happen under many different circumstances and happen much more frequently than most people realize. They are intensely personal; many experiencers are reluctant to talk about the experience unless they are sure the person is open to listening.
Common circumstances under which NDEs occur include:
• allergic reactions;
• acute illness;
• combat trauma;
• suicide attempts;
• terminal illness; and
Many individuals who have had NDEs experience lifelong aftereffects that may be either short-term or long-term and may take time to integrate. Initial psychological effects typically will be eased with support, while others will be integrated on a lifelong basis.
Some patients are angry after they are resuscitated. For example, the unconscious NDE patient describes hearing everything being said by healthcare personnel and becoming frustrated because, although his or her physical body is without pulse and breath sounds, their "spirit" is hovering and trying to communicate with clinicians.
In addition, NDE patients describe having been in excruciating pain, but the minute they left their physical body all pain disappeared. Patients also describe being told they must "come back"; as they settle back into the physical body, all the physical pain returns.
NDE patients describe being in the most loving and wonderful place they had ever known, but suddenly are hauled out of this peaceful place and sent back to their broken body. Thus, it is easy to understand an angry reaction.
Although no two experiences are alike, similarities are present across cultures, age, religion, education and gender. Although backgrounds may change how the experience is described, NDE characteristics have themes in common. Most experiences are described as peaceful, loving and wonderful regardless of the patient's background. However, a small proportion of people describe experiences that are more lonely and distressing.
In addition, many of these experiences, such as a near drowning, accidents and MIs, may happen prior to the patient's arrival at the heathcare setting. These patients may have had the experience at the site, in the ambulance or at home. Yet the experience is usually very clear in their mind and will be a lifelong memory and journey.
It also is significant to note children have NDEs. However, according to Atwater and Morse, children have a higher incidence and some different elements and aftereffects. One difficulty is that NDE experiences may happen to children who are very young possibly too young to talk. Children who experienced difficult births, illnesses or accidents at an early age may have had an NDE and, consequently, have lingering aftereffects.
It is critical to acknowledge the NDE as soon as possible, as many of these children realize they are unusual from a very early age but do not know why. It is necessary for these children to get support. Otherwise, they may spend years feeling isolated and different. The beauty of children is they often simply tell you what happened to them.
In his book Closer to the Light, pediatrician Melvin Morse relates his experience with a near-drowned child who was severely comatose. He details how the girl described his resuscitation efforts, which she said she observed during her NDE. P.M.H. Atwater has interviewed many children and written several books describing her findings about childhood NDEs. She has found these children generally have higher IQs, have enhanced vocabulary at an early age and are very different children after the NDE. Children are critical to the NDE literature, as they simply tell their truth. More studies of children and newborn NDE are needed, so they may be followed over time and differences in their lives can be quantified.
On a daily basis, thousands of patients are in hospitals, hospices or at home after having had an NDE. Many have not had the benefit of sharing that experience with a healthcare professional or family member. Thus, the near-death experiencer is left struggling to understand the experience in isolation. Nurses can provide essential support if they are knowledgeable and prepared to care for these patients.
To assist these patients, nurses can encourage experiencers to write about their experience in as much detail as possible and also discuss the experience with a nurse, supportive family member or friend. Another nursing strategy is to make available articles, lists of books and the Web address for the International Association of Near-Death Studies (IANDS), which provides information and support groups. Often, however, patients leave the hospital before they have had the chance to talk to someone; therefore, if it is suspected a patient has had an NDE, nurses should tell them they are always welcome to come back and discuss their hospital experience.
Several lingering aftereffects have implications for care of NDE patients. Those that are especially important for nursing and medical care include:
• increased sensitivity to medications of all kinds;
• core body temperature is routinely down in the 96-97º F range;
• blood pressure lower than prior to the NDE;
• increased allergies and sensitivity to chemicals in soaps, lotions, etc.; and
• interactions with electronic equipment, for example, inability to wear battery-run watches.
Other lingering effects of the NDE have to do with basic values, jobs and life purposes. For example, NDE patients may:
• no longer fear death;
• become less materialistic, change to altruistic jobs, do more service for others;
• become more spiritual, affectionate, emotional;
• possess new knowledge, "gifts" (e.g., healing, psychic ability), information;
• feel sadness, loneliness, alienation;
• have difficulty describing the experience; and
• have increased sensitivity to light, noise, violence.
While the experience may seemingly be positive, others often misunderstand it. A soldier, for example, suddenly may not be able to tolerate violence or fighting; a child may no longer want to play team sports; a stockbroker may lose interest in making money. These types of changes are difficult for family members who may be unable to adjust their lives to the new goals of the near-death experiencer. NDE patients may feel lonely and lost until they are able to work out these issues, meet other NDE patients, and/or understand the NDE and its aftereffects.
Many aftereffects become apparent over time, and some can be difficult to accept, such as a healing or psychic ability. The NDE patient often is starting a very new and different journey in life.
The nurse is likely to be the first person a patient sees following an NDE in a hospital. Patients are frequently afraid to tell their physicians, knowing they may not believe their story. Moreover, the reaction of the first person who hears the patient's story plays a critical role in the course of an NDE patient's journey. Knowledgeable nurses can facilitate the necessary process of supporting NDE patients. Patients will look to nurses for guidance and emotional support. While nurses know patients regularly have NDEs, they frequently don't know what to say or do to help the patient.
Basic guidelines for nurses to follow include:
• listening to the patient's story, listening for clues;
• being open, non-judgmental, accepting;
• being supportive, including supporting patient in telling family;
• affirming the experience, avoiding rejection or discounting of the experience;
• providing reading materials and list of resources;
• finding referral sources upon request; and
• giving patients the Web address and phone number for the IANDS.
The IANDS is a key resource for NDE patients, educators, researchers and healthcare providers. It offers support groups in most states and voluminous literature on its Web site. The association sponsors an annual conference attended by clinicians and near-death experiencers. The 2006 conference will be in Houston, co-hosted by MD Anderson Cancer Center.
Although researchers continue to probe current understanding of NDE, funding for projects is limited. Because more research is needed to answer questions surrounding NDE, IANDS is working to obtain donations to support NDE research.
Skeptics who question the reality of the NDE tend to be professionals who believe only what can be proved by science. However, over the years, more physicians and other scientists have joined the ranks of the believers. For example, Claude Swanson, a physicist who trained at MIT and Princeton, recently published a book called The Synchronized Universe (2005). He provides evidence about how physics can be used to understand phenomena such as NDE, and such emerging new evidence is beginning to shake the foundations of physics.
For some, believing happens in a minute during an actual experience; for others, believing comes over time by listening to patients tell their stories. I heard my first experience in Vietnam from a young soldier who was severely injured and described his NDE. It was 1969 and the term NDE did not exist, but I had never heard a patient describe such an experience. His story's detail, raw innocence and profound clarity started my journey with NDE patients.
As you are reading this, nurses around the world are hearing patients describe NDEs. Still, many may not recognize the NDE or, in some cases, are dismissing or misdiagnosing the event. In many instances, patients have been told by their physicians they are having a drug reaction, anoxia or hallucinations. It is imperative, therefore, that nurses be supportive and take an active role in educating patients, families, friends and other professionals.
There are numerous resources available for providers and families. Sharing these resources and experiences is essential for healthy integration of the NDE into patients' lives. Sharing the NDE enriches the lives of both caregivers and patients. As a nurse, knowing about NDEs may change your life forever.
Atwater, P.M.H. (2001). Coming back to life. New York: Citadel.
Bush, N.E. (2002). Afterward: Making meaning after a frightening near-death experience. Journal of Near-Death Studies, (21)2, 99-133.
Callanan, M., & Kelly, P. (1992). Final gifts. New York: Bantam.
Corcoran, D. (1988, November). Helping patients who've had near death. Nursing88, pp. 35-39.
Fenwick, P., & Fenwick, E. (1995). The truth in the light. New York: Berkley Books.
Greyson, B. (2000). Near-death experiences. In E. Cardena, S.J. Lynn & K. Krippner (Eds.), Varieties of anomalous experience: Examining the scientific evidence. Washington, DC: American Psychological Association.
Horacek, B.J. (1997). Amazing grace: The healing effects of near-death experience on those dying and grieving. Journal of Near-Death Studies, 16(2), 149-161.
Ring, K. (1990). Lessons from the light. Portsmouth, NH: Moment Point Press.
Moody, R. (1975). Life after life. New York: Bantam.
Morse, M. (1990). Closer to the light. New York: Galantine.
Suleman, A. (2005). A passage to eternity. Calgary, Alberta, Canada: Amethyst Publishing.
Diane Corcoran, a retired colonel in the Army Nurse Corps, is past president of IANDS and currently serves on its board of directors. She presents workshops nationally and internationally on the NDE role for healthcare providers. She has spent 30 years educating and supporting the NDE field in VA and military hospitals. Contact her at Dcorcoran@nc.rr.com.