This study examined the applicability of the Multidimensional Fear of Death Scale (MFODS; J.W.Hoetler, 1979a) in Lithuania, a culture where death anxiety has not been studied previously. It also ascertained the relationship between death anxiety and a multidimensional measure of religiosity. Confirmatory factor analysis indicated that MFODS structure fit the Lithuanian data reasonably well, particularly if factors were allowed to be correlated. Lithuanian participants who expressed higher levels of intrinsic religiosity also expressed less fear of the unknown, but no other independent, linear relationships existed among the various dimensions of religiosity and death anxiety.

ĮvadasLietuvos sveikatos informacijos centro Naujagimių registro duomenimis, šalyje kasmet gimsta daugiau kaip 29 tūkstančiai naujagimių, iš kurių daugiau kaip 5 proc. -neišnešiotų naujagimių. Šių naujagimių iš-gyvenamumas kasmet didėja (1).Neišnešioto naujagimio gimimas ir hospitalizacija į Naujagimių intensyviosios terapijos skyrių (NITS), jo atskyrimas nuo šeimos sukelia tėvams stresą (2). Kartais skirtumas tarp to, ko tikėjosi, ir realybės yra toks didelis, kad tėvams gali pritrūkti patirties ir socialinių įgūdžių įveikti emocijas. Todėl pagalba neiš-nešiotam naujagimiui neatskiriama nuo pagalbos jo šeimai šiuo laikotarpiu įveikti sunkumus (3). Šios pagalbos būtinumas paremtas holistiniu požiūriu į šeimą ir jos situaciją. Remiantis šiuo požiūriu, vaiko sveikatos sutrikimas apima ne tik biomedicininius, bet psichologinius, socialinius bei ekonominius visos šeimos funkcionavimo aspektus (4). Tik gimęs neišnešiotas naujagimis yra visiškai priklausomas nuo jį supančių žmonių, t. y. tėvų ir specialistų. Savo ruožtu tėvai yra labai priklausomi nuo gydymo įstaigos aplinkos, kurią sudaro įstaigos fizinė aplinka, skyriuje vyraujančios taisyklės bei specialistų požiūris į kūdikį ir šeimą. Visi šie veiksniai tarpusavyje yra susiję ir nulemia kūdikiui ir šeimai teikiamų paslaugų kokybę (3).

Background:The article presents an analysis of the formulation and implementation of a social innovation: integrated home care (IHC) in post-soviet Lithuania. From 1998 a series of top-down orders to implement IHC were issued, however, home nursing did not start. In 2011 the Ministry of Social Security and Labour began a process to develop integrated home care using new, collaborative processes. The result was 21 pilot projects with well-conceptualized IHC services.Method:Using data from focus groups, interviews, and recorded observations, the research team systematically documented the innovation process, including themes and deviations, employing Smale’s Innovation Trinity framework to organize the larger picture.Results:In the Lithuanian post-totalitarian context, top-down communication was found to be prevalent. Not only IHC, but also openness to change and dialogue at high levels were innovations. Patient-centered practice at local levels could only occur when a new attitude of mind was reached through dialogue with officials at higher levels and between peers.Conclusions:The enactment, rather than the mask of dialogue, participatory program development were critical in the success of IHC innovation. This is difficult to achieve in the light of antiquated public bureaucracies, but in this case, the Ministry team, rather than avoiding the expectation of top-down communication, made it into an asset through promotion of collaboration.

Background: The literature on professionals’ perceptions of dignity at the end-of-life (EOL) shows that there is a need for studies set in different cultural contexts. Lithuania represents one of these little-studied contexts. The aim of this study is to understand professionals’ attitudes, experiences, and suggestions concerning EOL dignity to provide knowledge upon which efforts to improve EOL care can be grounded. The research questions are “How do Lithuanian health care professionals understand the essence of dignity at the end-of-life of terminally ill patients?” and “How do they believe that dignity at the EOL can be enhanced?”. Materials and Methods: The study was exploratory and descriptive. It employed an interpretive phenomenological method to understand the essence of the phenomenon. Lightly structured interviews were conducted with professionals who had EOL experience, primarily with elderly and late middle-aged patients. from medicine, nursing, social work, and spiritual services. The interviews were primarily conducted by audiovisual means due to pandemic restrictions. Using a constant comparative method, the research team systematically codified text and developed themes by consensus after numerous analytic data iterations. Results: Four primary themes about EOL dignity were identified: Physical Comfort, Place of Care and Death, Effects of Death as a Taboo Topic, and Social Relations and Communication. A fifth, overarching theme, Being Heard, included elements of the primary themes and was identified as a key component or essence of dignity at the EOL. Conclusions: Patient dignity is both a human right and a constitutional right in Lithuania, but in many settings, it remains an aspiration rather than a reality. Being Heard is embedded in internationally recognized patient-centered models of EOL care. Hearing and acknowledging individuals who are dying is a specific skill, especially with elderly patients. Building the question “Is this patient being heard?” into practice protocols and conventions would be a step toward enhancing dignity at the EOL.