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Spirituality of Caretakers and End of Life SPIRITUALITY OF CARETAKERS AND END OF LIFE CARE _________________________________ A Dissertation Presented to the Faculty of the California Graduate Institute of The Chicago School of Professional Psychology ________________________________ In Partial Fulfillment Of the Requirements for the Degree Doctor of Philosophy in Clinical Psychology ________________________ By Duraiyah Thangathurai March 2010 ProQuest Number:10280460 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. ProQuest 10280460 Published by ProQuest LLC ( 2017). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106 - 1346 The dissertation of Duraiyah Thangathurai is approved. _______________________________________________ Donald Schultz, PhD, TCS-CGI Reader _______________________________________________ Kathy MacLeay, PhD, TCS-CGI Reader _______________________________________________ Maggy Riad, MD, MSEd., External Reader _______________________________________________ Terry Webster, PhD, Chair California Graduate Institute of The Chicago School of Professional Psychology West Los Angeles, California 2010 © 2009 by Duraiyah Thangathurai All rights reserved (Thangathurai, 2009) Dedication To my beloved father, mother, siblings, and family members, To my spiritual Guru Bhagavan Sri Sathya Sai Baba To my patients, students, residents, professors and teachers To the Divine and Inspiring spiritual images namely Durga, Sarasvathy, Luxmy, Kali, Quadleupe, Shiva, and many others sacred images. Acknowledgements Throughout my life, many people have inspired me, including my teachers, colleagues, students, residents, care providers, friends, relatives, patients and their family members. There are far too many to mention, but I sincerely appreciate their contribution to my growth, development as a physician, and to patient centered care. I would like to express my gratitude to the members of my dissertation committee. I extend my sincere thanks to my dissertation chair, Dr. Terry Webster, Dean of Westwood Campus for her continued support, guidance, motivation, and encouragement. I am grateful to my internal readers Dr. Donald Schultz and Dr. Kathy MacLeay for their wisdom and help; and my external reader Dr. Maggy Riad of UCLA for innovative ideas and assistance. I would also like to thank Patrick Murphy, JD, MD, for his guidance and encouragement. I am also grateful to Agnes Cheng for her patience and dedication to the completion of this dissertation and for her outstanding secretarial assistance. I would like to express my gratitude to Dr. Jennifer Selig, Dr. Gay Bradshaw, Dr. Maurice Stevens, Dr. David Bona, and Mike Denney MD, PhD from Pacifica Institute for their guidance and encouragement. I am obliged to the teachers of California Graduate School and Chicago School of Professional Psychology, namely Dr. Mayhall, Dr. Larry Peters, Dr. M. Koven, Dr. T. Oleson, and Dr. Russell Hunter. I am appreciative to the teachers of the Psychology Department at the Pepperdine University, namely Dr. Geoffrey Buckley, Jerome Front MA, MFT, Dr. Jack Lipton, and Dr. Maura Mitrushina. I am thankful to Professor Scott Rae, and the postgraduate students of philosophy from the Biola University for participating in clinical rounds relating to end of life care issues. I am grateful to Professor Winston JD and Professor Victor Condi JD of Simon Greenleaf and Trinity International University. I am grateful to Professor Seymour Greitzer JD, Dean and President Glendale University College of Law and Professor Michael Schmitt MA, JD of Southwestern Law School for their compassion and support. I am indebted to my close associates Peter Roffey MD, Mariana Mogos MD, Maged Mikhail MD, for their guidance, spiritual support, and intellectual dialogue and discussions relating to holistic care. I appreciate the contribution of Senior Professors at Keck School of Medicine of USC, namely Donald Skinner MD, William Shoemaker MD, FCCM, Thomas DeMeester MD, John Stein MD, Jack Berger MD, Rodney McKeever MD, Paul Morrow MD, Maurice Hitchcock PhD, Earl Strum MD, Wayne Kaufman MD, JD, Vladimir Zelman MD, PhD, Ronald Katz MD, JD and John Viljoen MD who supported me in the healing care of many cancer patients. I would like to extend my gratitude to my fellow faculty members, residents, and colleagues at the University of Southern California Keck School of Medicine, including Jay Roby MD, Lalani Perera MD, Zhang Wang MD, Narasimha Gundamraj MD, Kim Ngo MD, Crisanjali Rajaratnam MD, Andre Atoian MD, Najmeh Sadoughi MD, Shanika Perera MD, Hassan Reham MD, Jayeshkumar Patel MD, Mihir Desai MD, N. Senthilkumar MD, and Kathy Dressler RN, NP. I would like to extend my sincere gratitude to the intensive care unit and operating room nurses, doctors and staff from all the hospitals where I have worked. I would like to thank my previous colleagues C. Pathmajah MD, Jerome Costa MD, Shun Sunder MD, and Wendy Stub MA, JD. I would like to mention and acknowledge the mentoring figures from London, Dr. T. H. S Burns FFARCS, Dr. R. Jayaweera FFARCS, Dr. Peter Simmons FFARCS, Dr. Ian Gregory FFARCS, MRCP, Dr. A. Braganza MBBS, DA and Dr. C. Harvard FRCP, who were my role models and inspired me during the early years of my journey relating to humanistic care of patients and the art of medicine. These mentors taught at popular medical institutions in London, namely Royal Northern Hospital, Royal Free Hospital, and Charing Cross Hospital (London University). I would like to thank the physicians/teachers from Sri Lanka, including Dr. Michael Abeyaratne FRCS, Dr. Dharamadasa FRCP, N. Karunaratne FRCS, Jerry Jayasekara FRCS, and Gnasundran FFARCS for my early clinical training. I would like to express my appreciation to my former high school teachers Pararajasingam, Puvanam Kandiah, Mahilrajah, and Sangra Pillai who instilled innovative and creative ideas within me. I am grateful to my uncles P. Thambiayah and Captain K. ChandraPragasam BSC, OBE (UK), my childhood mentors, Mr. E. Sivapatham, E. Yoganathan BSC, and my cousins K. Chelvanayagam and K. Tharmalingam who sparked my interest in art and culture. I would like to express my deepest gratitude and acknowledge my brothers, sisters, friends, and many family members including my loving children and especially my brother, ThuraiRajasingam, for their spiritual, humanistic, and intellectual support. Finally, I owe deepest regards and respect for Margaret and Christine, both of whom played an important role in my life. DISSERTATION ABSTRACT SPIRITUALITY OF CARETAKERS AND END OF LIFE CARE Duraiyah Thangathurai California Graduate Institute of The Chicago School of Education March 2010 Terry Webster, PhD, Chair Donald Schultz, PhD, & Kathy MacLeay, PhD, Internal Readers Maggy Riad, MD, External Reader This dissertation is based on the study of the spirituality of caretakers, mainly physicians and nurses, with regard to its effect on the care of terminally ill patients. Terminally ill patients, in addition to physical symptoms, have many spiritual issues in their final days of life. While historically spiritual care has been available for many centuries it is becoming more and more neglected with the advancement of science and technology. These advances, however, do not significantly alleviate patient suffering related to psychological, spiritual, and social aspects. Now there is a renewed interest in the area of spirituality and people have again become aware of the importance of caring for the dying patients and their families. Numerous studies over the last two decades i support the therapeutic effect of spiritual care, but these studies concentrate more on the perspective of the patient and the family members. The literature search is based on the historical development of spirituality in various parts of the world. This approach gives a broader perspective on spirituality that goes beyond the limitations of religion and culture. Spirituality is further explored in terms of psychological, philosophical, and sociological contexts. The psychological areas focus on existential themes. The review also incorporates other psychological aspects such as psychodynamic, humanistic, imaginal, and transpersonal principles. Additional areas of the review emphasize and examine the importance of spiritual care relating to elderly patients. The current dissertation is based on patients in a cancer hospital who were admitted to the intensive care unit (ICU). The spirituality of caretakers was evaluated by interviews, surveys, and case studies. The evaluation was mainly carried out on experienced physicians in an academic setting and on those involved in the care of the patients in the ICU. The results show that spirituality of caretakers has a beneficial effect on the spiritual care provided to the patients. ii INTRODUCTION I have been taking care of patients for over 30 years. These patients have suffered from a variety of ailments including cancer, traumatic injuries, severe heart or pulmonary disease, and end stage-liver or kidney disease. For those who became terminally ill I was able to
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