Grand Valley State University ScholarWorks@GVSU Masters Theses Graduate Research and Creative Practice 1998 The onceptC of Death Education on Children's Understanding of Death Diana K. Clark Schramm Grand Valley State University Follow this and additional works at: http://scholarworks.gvsu.edu/theses Part of the Nursing Commons Recommended Citation Clark Schramm, Diana K., "The oncC ept of Death Education on Children's Understanding of Death" (1998). Masters Theses. 373. http://scholarworks.gvsu.edu/theses/373 This Thesis is brought to you for free and open access by the Graduate Research and Creative Practice at ScholarWorks@GVSU. It has been accepted for inclusion in Masters Theses by an authorized administrator of ScholarWorks@GVSU. For more information, please contact [email protected]. THE CONCEPT OF DEATH EDUCATION ON CHILDREN'S UNDERSTANDING OF DEATH By Diana K. CLARK SCHRAMM A THESIS Submitted to Grand Valley State University in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN NURSING Kirkhof School of Nursing 1998 Thesis Committee Member: Cynthia Coviak, Ph.D., R.N, Sharon Leder, D.S.N., R.N. Daniel Hendrickson, M.S.W. ABSTRACT THE CONCEPT OF DEATH EDUCATION ON CHILDREN'S UNDERSTANDING OF DEATH By Diana K. Clark Schramm The purpose of this investigation was to determine if death education has an impact on children's understanding of death. This study was a non-randomized trial of a single educational session on death concepts of 38 second grade children (mean age 7.78 years). The Smilansky Death Concept Questionnaire, a validated and published interviewing tool, was administered pre- and post intervention to all study subjects to evaluate their understanding of death. This intervention was a story on death and a peer group discussion. Posttest scores were significantly higher than pretest scores for human death concept, and animal death concept, as well as on the total death concept. There were no significant relationships between demographic variables and the Smilansky Death Concept scores. It is recommended that elementary schools consider incorporating a death education program into their current curriculum. Dedication This thesis is dedicated to my husband, Greg and my daughters, Katelin and Kristen. Without their love, understanding, and sacrifices my dream may never have become a reality. Acknowledgments I have many people to grateful to for supporting and encouraging me through my masters program. I would like to express my deepest appreciation to my committee. Their support and availability has enabled me to meet my goals and complete this project. I would also like to thank Linda Scott R.N., M.S.N., PH.D. Candidate, for her never ending patience, expertise, and availability. Special thanks goes to my parents, extended family, and exceptional friends who always believed in me even when I did not. To my mother for providing me with the extra hands and understanding I needed to complete my education. My most sincere thanks go out to my friends, Jennifer Jordahl and Debbie Provoast. These true friends were with me through the thick and thin of graduate school. Their support and love gave me strength to reach for the stars! Table of Contents List of T a b l e s ................................................. vi List of F i gures...............................................vii List of Appendices.......................................... viii CHAPTER 1 INTRODUCTION Introduction ........................................ 1 Purpose .............................................. 5 Research Question .................................. 5 Nursing Implications ............................... 5 2 CONCEPTUAL FRAMEWORK AND REVIEW OF LITERATURE Theory: Jean Piaget ............................... 7 Review of Literature .............................. 11 Studies on Developmental Level and Death Understanding .................... 11 Studies on the Death Education and Its Effects...............................16 Summary and Implications for Study ....... 24 Hypothesis ................................... 25 Definition of T e r m s ..........................25 3 METHODS Research Design ................................... 26 Sample and Setting ................................29 Instrument.......................................... 32 Procedure........................................... 36 4 R E S U L T S ................................................ 4 0 Other Findings of Interest....................... 44 5 DISCUSSION AND IMPLICATIONS Discussion of Findings ........................... 46 Relationship to Conceptual Framework .......... 51 Limitations of the S t u d y ..........................53 Recommendations ................................... 54 R e s e a r c h .......................................54 Nursing Education ........................... 57 Nursing Practice ............................ 58 IV Summary and Conclusion ......................... 59 APPENDICES...................................................... 61 REFERENCES...................................................... 79 List of Tables TABLE 1 Characteristics of Subjects.............................31 2 Summary of Smilansky Death ConceptScores ............. 41 3 Comparisons of Pre- and Posttest Death Concept Scores .................................... 42 4 Comparison of Demographics and Death Concept Scores .......................................... 43 VI List of Figures FIGURE 1 Piaget: Conceptual Framework 8 Vll List of Appendices APPENDIX A Consent to Use Piaget Conceptual Framework ............................... 61 B Human Subjects Review Committee Approval ....... 62 C Elementary School Approval......................... 63 D Letter to the Parents ...............................64 E Consent Forms ....................................... 66 F Personal Data Sheet ................................. 68 G Consent from Dr. Sara Smilansky................... 70 H The Smilansky Death Concept Questionnaire........ 71 I Smilansky's Scoring Tool ........................... 74 J Pretest Script ...................................... 75 K Intervention Questions ............................. 77 L Posttest script ...................................... 78 Vlll CHAPTER 1 INTRODUCTION Death is a reality that all human beings must endure at one time or another. As adults, death is complex and difficult to fully comprehend. Children have fewer life experiences and limited cognitive developmental skills to integrate death. Children require intellectual understanding of death before they can effectively process it emotionally. This understanding of the meaning of death is essential for the grieving process to progress (Schonfeld & Kappelman, 1990). Age-appropriate education can help adults and children process and prepare for the death experience. According to the wisdom of Buddha, we can actually use our lives to prepare for death. We do not have to wait for the painful death of someone close to us or the shock of terminal illness to force us into looking at our lives. Nor are we condemned to go out empty-handed at death to meet the unknown. We can begin, here and now, to find meaning in our lives. We can make every moment an opportunity to change and to prepare, wholeheartedly, precisely, and with peace of mind for death and eternity (Rinpoche, 1992, p. 257). Parents want to protect their children from the emotional pain death causes. However, it is inevitable that children are exposed to death. Children will need to accept and understand death as a natural process of life. Learning about death may help children to be better prepared to cope with their emotions and decrease their fears. Associated fears or anxieties can compound children's misconceptions about death. Death education can clear these misconceptions and help the children understand death at their developmental level (Labinowicz, 1980) . Education could help children understand that the feelings they may have are normal. It may help them understand the behavior of others who have experienced a death (Jones, Hodges, & Slate, 1995) . A growing movement exists to implement death education programs in elementary and secondary schools. The growing number of deaths in school-age children supports this movement (Jones et al., 1991), The three leading causes of death in school-age children are accidents, suicide, and homicides that are usually sudden and unexpected (Jones et al., 1991). Many schools provide grief counseling for children after a tragic death occurs in a community as crisis intervention. For example, crisis intervention was provided when a local Michigan high school experienced three unrelated student deaths within one school year. In another Michigan school district, a fatal motor vehicle accident claimed the lives of three grade school children. Each of the schools provided one day of grief counseling for their children, and further counseling was provided as appropriate for the children. The teachers fielded most of the questions, emotions, and tears in both situations. In an informal survey of seven elementary teachers, they felt that if their students had received death education prior to the loss, it might have helped them understand and grieve more effectively (M. Hayes, V.Charles, P. Reed, S. Dickerman, K. Wood, D. Southland, D. Dudack, personal communication, February, 1997). The emotional and cognitive impact of death on children, who are experiencing normal developmental changes, creates enormous stress on those children. Frequent behavior changes, such as crying,