Showing papers in "Death Studies in 2011"
TL;DR: This mixed-method study compared how parents and siblings experienced continuing bonds in 40 families who lost a child to cancer and found that mothers communicated with the deceased, thought about the dead child, and did things that the deceased child would have liked more often than siblings.
Abstract: Few studies have distinguished similarities and differences between continuing bonds as they appear in various bereaved populations, particularly parent versus sibling cohorts following a child's death. This mixed-method study compared how parents and siblings experienced continuing bonds in 40 families who lost a child to cancer. Thirty-six mothers, 24 fathers, and 39 siblings were recruited 3-12 months post-loss (M = 10.7, SD = 3.5). Nearly all participants (97%) reported engaging in purposeful bonds with deceased children, while only 14% reported nonpurposeful connections. Over half of participants (58%) experienced comforting effects from reminders of the deceased child, whereas only 10% of family members experienced discomforting effects. Mothers communicated with the deceased, thought about the deceased, and did things that the deceased child would have liked more often than siblings. Mothers also reported significantly more comforting effects than siblings. Additional research is needed to further delineate continuing bonds for different types of loss and examine associations with positive and negative outcomes for bereaved individuals.
114 citations
TL;DR: All human activities are framed by death anxiety and colored by the authors' collective and individual efforts to resolve this inescapable and intractable existential given.
Abstract: Death remains the biggest threat as well as the greatest challenge to humanity. It is the single universal event that affects all of us in ways more than we care to know (Greenberg, Koole, & Pyszcz...
113 citations
TL;DR: While participants found many benefits in what they experienced, finding meaning beyond immediate coping seemed to require the availability of spiritual/religious frameworks that could be adopted or, if available but discrepant, could meaningfully accommodate the experience.
Abstract: This qualitative study aimed to explore the potential role that might be played by the reported experience of ‘sensing the presence of the deceased’ in meaning-making processes in bereavement. Semistructured interviews were conducted with 12 participants who reported having had such an experience and the transcripts were subjected to thematic analysis. Seven overarching themes were identified, 3 of which were considered central: ‘finding benefit in the continuation of the deceased’, ‘finding benefit in the continued relationship’, and ‘finding meaning through existential, spiritual, and religious sense-making’. While participants found many benefits in what they experienced, finding meaning beyond immediate coping seemed to require the availability of spiritual/religious frameworks that could be adopted or, if available but discrepant, could meaningfully accommodate the experience.
82 citations
TL;DR: Investigation of how participation is experienced by those bereaved by suicide finds positive experiences are linked to processes of meaning-making, gaining new insight, and a hope to help others.
Abstract: Too often ethical boards delay or stop research projects with vulnerable populations, influenced by presumed rather than empirically documented vulnerability The article investigates how participation is experienced by those bereaved by suicide Experiences are divided into 3 groups: (a) overall positive (62%), (b) unproblematic (10%), and (c) positive and painful (28%) The positive experiences are linked to processes of meaning-making, gaining new insight, and a hope to help others Objective factors concerning the gender of participants, their relationship to the deceased, the method of suicide, and time since loss were largely unrelated to their experience of the interview
66 citations
TL;DR: Results showed that factors assessed in this investigation were significantly correlated with death attitudes and emotional health, and gender, ethnicity, intrinsic religiosity, social support, and future-related regret each were shown to have a unique impact on various aspects of EOL adjustment and distress.
Abstract: Although the role of spiritual, psychological, and social factors is receiving increasing attention in the end of life (EOL) context, we know far less than we need to about how these factors shape attitudes toward life and death in the face of looming loss. The present study begins to remedy these limitations by examining the relative impact of demographic characteristics, religious and psychosocial factors, and life regret on death attitudes and psychological wellbeing for a diverse group of 153 hospice patients. In addition to relying on well-validated quantitative assessments, qualitative interviews were conducted with participants to further illustrate the role of study factors in shaping various dimensions of death anxiety or acceptance and quality of life. In general, results showed that factors assessed in this investigation were significantly correlated with death attitudes and emotional health. When study factors were examined simultaneously, gender, ethnicity, intrinsic religiosity, social support, and future-related regret each were shown to have a unique impact on various aspects of EOL adjustment and distress. The article concludes by offering direction to researchers interested in integrating and extending the empirical study of the attitudes of adults facing serious illness, and underscoring the clinical implications of these findings for professionals offering psychosocial and spiritual care at the end of life.
59 citations
TL;DR: The authors suggest that therapists working with bereaved families first discuss the complexities of communication with the family members, specifically those concerning talking and keeping silent, and explore the different meanings associated with sharing grief experiences with each other.
Abstract: Sharing grief experiences, or "storying"grief can be a key resource in adapting to loss, one that can contribute to stronger bonds and relational intimacy within the family. In this article, the authors conceptualize communication between grieving family members in terms of 3 "D" processes, emphasizing the extent to which such communication is dialectic, dialogic, and dynamic in nature. They illustrate the complexity of sharing about a mutual loss, focused on these 3 features, by referring to a case study of a couple coping with the death of a child in the context of a newly formed family. Rather than unilaterally advocating the promotion of open communication, the authors suggest that therapists working with bereaved families first discuss the complexities of communication with the family members, specifically those concerning talking and keeping silent, and explore the different meanings associated with sharing grief experiences with each other.
57 citations
TL;DR: In this article, the authors present a theoretical framework for addressing miscarriage in clinical practice and research, based on data from three phenomenological investigations conducted with 42 women from diverse geographical locations, sexual orientations, and cultural backgrounds.
Abstract: In spite of scientific evidence that miscarriage has negative psychological consequences for many individuals and couples, silence and dismissal continue to surround this invisible loss in North American culture and beyond. The grief and sorrow of miscarriage has important implications for clinical practice. It indicates a need for therapeutic interventions delivered in a caring, compassionate, and culturally sensitive manner. This research, based on data from 3 phenomenological investigations conducted with 42 women from diverse geographical locations, sexual orientations, and cultural backgrounds offers a theoretical framework for addressing miscarriage in clinical practice and research.
56 citations
TL;DR: In this article, the author summarizes the elements necessary for using death-related ritual as a psychotherapeutic technique for grieving people who experience their grief as "stuck", "unending,” "maladaptive", and so on.
Abstract: This article summarizes the author's original research, which sought to discover the elements necessary for using death-related ritual as a psychotherapeutic technique for grieving people who experience their grief as “stuck,” “unending,” “maladaptive,” and so on. A death-related ritual is defined as a ceremony, directly involving at least 1 person and the symbols of the loss, and usually directly and indirectly involving others. Suggestions for counselors and psychotherapists are discussed.
50 citations
TL;DR: Assessment at 6 months after leaving the hospital showed that intervention fathers reported lower grief reaction scores and stronger personal growth, which support the continuation of the intervention.
Abstract: This article describes a study designed to evaluate the effectiveness of an intervention program for bereaved fathers and their experiences of it in a sample of intervention (n = 62) and control (n = 41) fathers. Data were collected by 3 scales: the Hogan Grief Reactions Checklist, a scale for measuring received social support, and a scale for measuring fathers' experiences of the intervention program. Assessment at 6 months after leaving the hospital showed that intervention fathers reported lower grief reaction scores and stronger personal growth. Intervention fathers reported the most emotional support from both health care personnel and peer supporters. The support received was perceived as helpful in coping, and fathers rated the intervention favorably. The findings support the continuation of the intervention.
49 citations
TL;DR: A model of funeral satisfaction is posits in which religiosity predicts general funeral attitudes, which predict levels and types of funeral participation, mediating the relationship between attitudes and satisfaction in a particular bereavement context.
Abstract: This study posits a model of funeral satisfaction in which religiosity predicts general funeral attitudes, which predict levels and types of funeral participation, mediating the relationship between attitudes and satisfaction in a particular bereavement context. Over a thousand respondents rated their attitudes toward funerals in general and evaluated the most recent funeral they had actually attended. The resulting model indicated that religiosity and favorable attitudes, when enacted through participation and involvement, tend to predict funeral satisfaction, in combination with favorable comparisons, and when the deceased was close and the death unexpected or tragic. Evaluations of the funeral, in turn, independently influence a person's general attitudes about funerals. Theoretical and practical implications for understanding funerals and bereavement are explored.
48 citations
TL;DR: The authors discussed key elements in a number of popular, independent, and international films and emphasized the use of films as an important adjunct for both teachers and clinicians addressing death attitudes with students and clients.
Abstract: The portrayal of death is one of the most common themes in movies and is often unrealistic, promoting misconceptions to the public. However, there are also many films that portray death acceptance in an instructive way. Such films depict the development of character strengths useful in embracing life and lessening death anxiety, namely zest, curiosity, self-regulation, and humor. Moreover, the role of meaning in films is pivotal for understanding death attitudes. The authors discussed key elements in a number of popular, independent, and international films and emphasized the use of films as an important adjunct for both teachers and clinicians addressing death attitudes with students and clients. A program of death education using movies is briefly discussed.
TL;DR: Fostering morality communication between secular caregivers and patients would appear to be one means of reducing the likelihood of clinically significant psychological distress, however, this may be insufficient among religiously observant caregivers, for whom fear of death may first need to be redressed.
Abstract: Previous research suggests that caregivers and terminally ill patients face substantial difficulties discussing illness and death. Existing research, however, has focused primarily on the experience of patients. The current study compared responses as well as the relative strength of association between mortality communication, fear of death, and psychological distress (i.e., depressive symptomatology, emotional exhaustion) among secular and religiously observant family caregivers of terminally ill cancer patients. A total of 236 participants were recruited over 18 months within the first year of caregiver bereavement. Retrospectively reported mortality communication was statistically greater among secular caregivers; in contrast, both fear of death and depressive symptoms were greater among the religiously observant. Path analyses subsequently revealed notable differences between groups. Among secular caregivers, a significant inverse relationship between mortality communication and the two indices of ca...
TL;DR: The findings indicated that Pakistani Muslims maintained their link with the deceased through cultural and religious rituals, such as performing prayers, reciting holy verses, talking and dreaming about the deceased, doing charity, visiting graves, and arranging communal gatherings.
Abstract: This study explores the bereavement process and continuing bond in Pakistani Muslims with the focus on how culture and religion influence these processes. Ten participants were interviewed and their transcribed interviews were analyzed using a grounded theory approach. Three main domains were identified from the narratives expressed by the participants: death and the process of grieving, continuing the link with the deceased, and influencing agents. The findings indicated that Pakistani Muslims maintained their link with the deceased through cultural and religious rituals, such as performing prayers, reciting holy verses, talking and dreaming about the deceased, doing charity, visiting graves, and arranging communal gatherings. The prime purpose of many of these practices was the forgiveness of the deceased. Grief reactions seemed to be determined by the nature of death, prior relationships with the deceased, reaction of society and gender of the bereaved. Religion provided a strong basis for coping and adjustment of the bereaved, through rationalizing and accepting the death. This study has important implications for counselors and family therapists who can use religious affliations to reduce the impact of loss and complicated bereavement.
TL;DR: For bereaved older adults, time-related meaning seeking may be best fostered by self-transcendence, (e.g., participation in volunteer work and social activities).
Abstract: Response to the death of a spouse was examined by focusing on acceptance, which was conceptualized as both a process and an outcome. Grounded theory was applied to analyze the experience of 15 bereaved Hong Kong Chinese older adults. The main theme that emerged was time. Acceptance of spousal death was found to be related to the search for meaning in 2 time-related themes: timing of spousal death and paradoxical time perception. For paradoxical time perception, 2 subthemes were identified: truncation and daily isolation in time. For bereaved older adults, time-related meaning seeking may be best fostered by self-transcendence, (e.g., participation in volunteer work and social activities).
TL;DR: This article analyzes 20 published book-length autobiographical stories of bereavement in which authors report after-death communications and identifies two functional patterns—instantaneous relief from painful grief symptoms and reinforcement of a consoling religious worldview.
Abstract: After-death communications (ADCs) are reported encounters with a deceased loved one, a contemporary type of ghost experience heralded as therapeutic in coping with bereavement. Pertinent literature generally illustrates the healing power of ADCs with brief, self-contained episodes. The functions of ADCs over the course of grief need exploration. To that end, this article analyzes 20 published book-length autobiographical stories of bereavement in which authors report ADCs. Two functional patterns are identified—instantaneous relief from painful grief symptoms and reinforcement of a consoling religious worldview. The second dynamic links ADCs to meaning-making and religious coping within Christian and Spiritualist frameworks.
TL;DR: The findings showed that while bereaved older adults, on average, experienced a moderate level of personal strength at 6 months post-spousal death with a slight increase over a 4-year period, there was a significant individual difference in the level ofPersonal Strength at 6 weeks post-SpousalDeath.
Abstract: This study was performed to identify the patterns and mechanisms of the development of personal strength of bereaved older adults over a 4-year period after spousal death. The findings showed that while bereaved older adults, on average, experienced a moderate level of personal strength at 6 months post-spousal death with a slight increase over a 4-year period, there was a significant individual difference in the level of personal strength at 6 months post-spousal death. Finding meaning was a crucial factor influencing interindividual differences in personal strength at 6 months post-spousal death, mediating between social support and personal strength as well as caregiving strain and personal strength. Having higher religiosity was directly associated with a higher level of personal strength.
TL;DR: It is concluded that a sizable minority of elders hold nonreligious spirituality beliefs, and these beliefs are related to greater acceptance of life extension and death rejection.
Abstract: Meanings of religious and nonreligious spirituality are explored, with implications for death acceptance, death rejection, and life extension. In the first of two exploratory studies, 16 elders low on intrinsic religiosity were compared with 116 elders high in religiosity; they differed both in qualitative responses and on death attitudes. In the second, 48 elders were assessed on religious and nonreligious spirituality and compared on attitudes toward death rejection, life extension, and death acceptance. Conclusions were that a sizable minority of elders hold nonreligious spirituality beliefs, and these beliefs are related to greater acceptance of life extension and death rejection.
TL;DR: Both ageist attitudes and behaviors correlated positively with risk-taking and are consistent with terror management theory's view of ageism as a buffer against death anxiety.
Abstract: The authors investigated the relationship between ageism and risk-taking in young adults. They hypothesized that young adults may attempt to distance themselves from their future older selves and from an awareness of their mortality by seeking out experiences that make them feel strong, energetic, and invulnerable (i.e., experiences involving risk-taking). We report a study whose results confirmed the hypothesis. Our study involved 408 undergraduates (226 women, 182 men) who completed the Centers for Disease Control's 2007 State and Local Youth Risk Behavior Survey and measures of 2 distinct aspects of ageism: (a) ageist attitudes and (b) ageist behaviors. Both ageist attitudes and behaviors correlated positively with risk-taking (i.e., sexual behavior, alcohol use, cigarette use, and drug use). The results are consistent with terror management theory's view of ageism as a buffer against death anxiety.
TL;DR: Many parents have only a few sexuality-related problems following a child's death, but a fairly large minority, especially women, experience major problems, and men are ready to resume activity in the sexual area much earlier than women.
Abstract: The aim of study was to increase our understanding of sexuality and intimacy following the loss of a child. A questionnaire on intimacy and sexuality was sent to 1,027 members of the 2 major bereavement support organizations for parents who have lost children in Norway. A total of 321 (33%) were returned. In addition, 10 couples were interviewed in depth about their experiences. The final sample (n = 285) consisted of 169 women (59.3%) and 116 men (40.7%) who represented 175 couples. Parents who were neither married nor cohabitants were excluded, as were nonbiological parents. Around 2/3 of the parents had resumed sexual contact within the first 3 months after their child's death. The activity of about 1/3 had been reduced. Significantly fewer mothers than fathers experienced sexual pleasure and close to 30% of the mothers reported that this had been reduced since the death. Only 11% noted that sexuality as an issue was raised in follow-up conversations. Many parents have only a few sexuality-related problems following a child's death, but a fairly large minority, especially women, experience major problems, There are clear gender differences in reactions and perceptions, often agreed upon by the 2 genders. Men are ready to resume activity in the sexual area much earlier than women. Women suffer much more from grief that in different ways intrudes on the sexual act and they more often perceive sex as somehow being wrong. Men also easily misunderstand women's need for closeness as a wish for sex.
TL;DR: The 5 phases of the Journey with the Dying identified here show the different adjustments and appraisals that GPs undertake to comprehend and to be able to work in the presence of death.
Abstract: A grounded theory study was undertaken to understand how general practitioners (GPs) experience the death of their patients. Eleven GPs participated in semi-structured interviews. The participants explained their experience of a patient's death using the “death journey” metaphor. This journey, the Journey with the Dying, could be described from 5 different moments in the participants’ encounters with people who are dying: private acknowledgement, communication of prognosis, continuity of care, the moment of death, and looking after the family. Emotional responses for each of the stages, and coping strategies in general, were outlined. GPs’ narratives about professional identity, learning about dying and death, and death beliefs were also important in the Journey with the Dying. The experience of death described by the GPs in this study was different from that reported by medical doctors in other care settings. The 5 phases of the Journey with the Dying identified here show the different adjustments and ap...
TL;DR: A known religion with a proscription against autopsy and a raised family concern appeared to be taken into account by coroners when making autopsy decisions and tended to decrease the invasiveness of the autopsy ordered from a full internal examination to either a partial internal examination or an external-only examination of the body.
Abstract: Based on coronial data gathered in the state of Queensland in 2004, this article reviews how a change in legislation may have impacted autopsy decision making by coroners. More specifically, the authors evaluated whether the requirement that coronial autopsy orders specify the level of invasiveness of an autopsy to be performed by a pathologist was affected by the further requirement that coroners take into consideration a known religion, culture, and/or raised family concern before making such an order. Preliminary data reveal that the cultural status of the deceased did not affect coronial autopsy decision making. However, a known religion with a proscription against autopsy and a raised family concern appeared to be taken into account by coroners when making autopsy decisions and tended to decrease the invasiveness of the autopsy ordered from a full internal examination to either a partial internal examination or an external-only examination of the body. The impact of these findings is briefly discussed.
TL;DR: This study gives voice to the experiences of gay men who have lost a partner to non-AIDS-related causes, a subject that has received little attention in the psychological literature.
Abstract: This study gives voice to the experiences of gay men who have lost a partner to non-AIDS-related causes, a subject that has received little attention in the psychological literature. Interviews were conducted with 8 gay men. An analysis informed by hermeneutic phenomenology generated themes and contexualized meanings regarding the participants' diverse experiences. The themes identified areas of similarity and difference between the bereavement of these participants from those who have participated in general bereavement studies and from those who have lost a partner to AIDS. Implications for counseling practice and further research are discussed.
TL;DR: The authors introduce the virtual dream, a technique that entails writing a brief, spontaneous dreamlike story on themes of loss, using a flexible set of assigned elements of setting and characterization to scaffold the writing.
Abstract: In this article, the authors introduce the virtual dream, a technique that entails writing a brief, spontaneous dreamlike story on themes of loss, using a flexible set of assigned elements of setting and characterization to scaffold the writing. After providing several examples of virtual dreams written by workshop participants, the authors analyze the frequency of important narrative features in a diverse sample of 143 stories to demonstrate the feasibility and reliability of coding such accounts for clinical or research purposes. Finally, we conclude with some remarks on the therapeutic use of the virtual dream, whether as a prompt for personal reflection on themes of loss, as an exercise in the context of grief workshops or support groups, or as a homework assignment in grief counseling or therapy.
TL;DR: In this article, the authors validated the use of the Korean version of the Reasons for Living Inventory for Adolescents (KRFL-A) in a group of 406 South Korean high school students.
Abstract: The present study validated the use of the Korean version of the Reasons for Living Inventory for Adolescents (KRFL-A) in a group of 406 South Korean high school students. Confirmatory factor analysis confirmed the original 5-factor and other psychometric properties demonstrated the usefulness of the KRFL-A as a measure of cognitive protective factors. Hierarchical regression analyses revealed that the KRFL-A total significantly moderated the impact of depressive symptoms on suicidal ideation. More specifically, the Family Alliance subscale among boys and the Peer Acceptance and Support subscale among girls moderated the relationships between depressive symptoms and suicidal ideation. This suggests that for Korean adolescents, gender-specific strategies are needed for more effective suicide interventions.
TL;DR: The results of this qualitative study indicate that all 3 generations were believers in the afterlife and the karmic philosophy, however, they exhibited differences in the degree to which Hindu traditions surrounding death and bereavement have been influenced by the fact that they live in the United States.
Abstract: The purpose of this article was to explore Asian Indian American Hindu (AIAH) cultural views related to death and dying. Three focus group interviews were conducted with AIAH persons living in the southern region of United States. The focus group consisted of senior citizens, middle-aged adults, and young adults. Both open-ended and semistructured questions were asked to elicit discussions that would uncover the meanings respondents attribute to death, as well as their pre- and post-death practices. All the sessions were tape recorded. Two independent researchers examined the transcripts of the 3 sessions and generated common themes. The results of this qualitative study indicate that all 3 generations were believers in the afterlife and the karmic philosophy. However, they exhibited differences in the degree to which Hindu traditions surrounding death and bereavement have been influenced by the fact that they live in the United States. Implications for service providers are included.
TL;DR: It is suggested that grief and the students' construction of the meaning of their loss can mediate theStudents' developing sense of self as a professional helper.
Abstract: This study explored the impact of prior personal experience with grief on self-reported personal and professional development of graduate students in nursing, social work, counseling, pastoral care, and genetic counseling involved as cofacilitators in bereavement support groups, and of medical students observing interdisciplinary inpatient palliative care. Personal experience with death of a family member or close friend was reported in 80% of the 35 participating students. Findings suggest that grief and the students' construction of the meaning of their loss can mediate the students' developing sense of self as a professional helper. Active engagement with suffering persons, the opportunity for self-disclosure and reflection, and teacher-facilitator provision of emotional guidance and modeling contributed positively to learning.
TL;DR: The results show that the factor structure of attitudes toward dying and death that had been established empirically with German people can be replicated with Chinese students of Hong Kong.
Abstract: This study examines the factor structures of the Chinese version of the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F/ chin), originally established in German language, in a sample of Hong Kong college students (n = 256). Both confirmatory factor analysis and exploratory factor analysis were performed to examine the factor structures of the MODDI-F/ chin. The results showed that, identical to the German version, the MODDI-F/chin consisted of a 5-factor Fear domain and a 3-factor Acceptance domain. The fear of another person's dying was the weakest of the four factors in the Hong Kong sample but represented the first and strongest factor in the German sample of the original study. Although preliminary and not representative of mainland China, our results show that the factor structure of attitudes toward dying and death that had been established empirically with German people can be replicated with Chinese students of Hong Kong.
TL;DR: It is suggested that avoidance behaviors in homicidal cases are more closely associated with a distant family relationship, whereas conjugal loss is traumatic, irrespective of the manner of death, often causing hyperarousal and maladaptation symptoms.
Abstract: The authors investigated posttraumatic stress disorder (PTSD) symptoms in Japanese bereaved family members using a questionnaire. Participants were bereaved as a result of suicide and homicide (n = 51 and 49, respectively), with natural death (n = 56) as a control; and their relationships to the deceased were parent–child (n = 79), conjugal (n = 42), and others (n = 35). With regard to the 3 main PTSD-related criteria, (a) re-experiencing symptoms were not dependent on the manner of death or the relationship to the deceased; (b) avoidance behaviors were more highly related to homicide than natural death for relatives other than parent–child and conjugal relationships; and (c) hyperarousal and maladaptation symptoms were more serious for conjugal loss. These findings suggest that avoidance behaviors in homicidal cases are more closely associated with a distant family relationship, whereas conjugal loss is traumatic, irrespective of the manner of death, often causing hyperarousal and maladaptation symptoms.
TL;DR: Health services will be called upon to train health care professionals to work with dying people in a more participatory way and to assist them to develop the clinical processes that support shared decision making.
Abstract: The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be effective, health care professionals who provide hospital care will need to respond to its patient-centered purpose. Health services will also be called upon to train health care professionals to work with dying people in a more participatory way and to assist them to develop the clinical processes that support shared decision making. Health professionals who manage clinical workplaces become central in reshaping this practice environment by promoting patient-centered care policy objectives and restructuring health service systems to routinely incorporate patient and family preferences about care at key points in the patient's care episode.
TL;DR: A modified grounded theory methodology project was used to explore how workers make sense of, respond to, and cope with sudden death and a theory that described the positive framing of death emerged emerged.
Abstract: Homeless sector workers often encounter the deaths of service users. A modified grounded theory methodology project was used to explore how workers make sense of respond to, and cope with sudden death. In-depth interviews were undertaken with 16 paid homeless sector workers who had experienced the death of someone with whom they worked. Transcripts of interviews and field notes were analyzed using the constant comparative method and a theory that described the positive framing of death emerged. Dealing with death and trauma is not something that most workers expect when they begin work but exposure to the death of a service user heightens expectations that other service users may be harmed. How workers cope or positively frame death depends on several interlinked processes. These include how the death is encountered; how the worker and others mark the death; and the extent that the vulnerability of self, peers, and service users is recognized and responded to. Successfully framing death enables the worker to continue working in the sector whilst maintaining enthusiasm for the work and compassion for service users.