Review
The divided self: Near death experiences of resuscitated patients – A review of literature

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Abstract

This paper explores the prevalence of ‘near death experience’ phenomena associated with a resuscitation event and examines the current state of evidence for causation. Patients’ reports of unusual recollections associated with a period of unconsciousness (perceived as approaching death) have fascinated individuals and the medical fraternity. Near death experiences (NDE) are reported in 4–9% of general community members and up to 23% of critical illness patients, although they can occur in healthy individuals who may think they are in peril. One explanation is that paranormal visions that include seeing bright lights, a tunnel and having feelings of peace may be a stage of enlightenment as death approaches. More objective explanations point to neuro-chemical changes in a stressed or dying brain as explanation for nearly all the elements of near death experience. However if this is so, NDE should occur in all patients who are critically ill and near death. In general, patients report positive psychological outcomes after a near death experience. Nurses can support patients during a time of crisis by assisting them and their families to comprehend the experiential event using effective communication and listening skill.

Introduction

Since time immemorial, man has struggled to comprehend human death and the possibility that there is a life beyond. In medieval times, supernatural visions or out of body experiences were thought to offer an explanation for journeys to another world. These transcendental experiences were given religious connotations in both western and eastern religious traditions including Christianity, Judaism, Buddhism and Hinduism, often with promise of reward in the next life (Masumian, 2009). John Wesley (the founder of Methodism), believed there was an intermediate stage between life and the final resolution of death (Campbell 1999) and visions were associated with this phase of ‘dying’. Over several centuries there has been discussion of the likely significance of these transcendental experiences, though without resolution of their cause or meaning.

The term ‘near death experience’ (NDE) was coined by a physician (Moody, 1975) who claimed that near-death survivors reported positive visionary experiences of passing down a dark tunnel towards a bright light. Some suggest that ‘the light’ has supernatural qualities (Baumann, 2005) and that those who decided to return to life from unconsciousness felt changed for the better. Subsequently, a study of 101 randomly selected near-death survivors by Ring (1982) showed that NDE was not uncommon. Two-thirds reported a feeling of peace during the experience with a quarter entering a tunnel of darkness. One-third reported out of body experience with perceptions of floating above their own physical form.

NDE has become a field of study in psychology and psychiatry and is defined by Morris and Knafl (2003) as: “the report of unusual recollections associated with a period of unconsciousness during either serious illness or injury, or resuscitation from a cardiac or respiratory arrest” (p. 140). However, individuals who are not seriously ill (but who think they are dying) have been recorded as experiencing NDEs (Owens et al., 1990, Irwin, 1985).

Curiosity about the origin and prevalence of NDEs has escalated as technology and resuscitation techniques have improved. Interest in the topic is high: the search engine Google Scholar offers over 440,000 articles about NDE many of which relate to spirituality or an afterlife. The medical literature reports 78 studies in Ovid Medline and 347 in PsycInfo. Many of these, however, are based on opinion or comment.

Emergency department nurses will be faced with patients who have had NDEs but may not identify this has occurred, and therefore fail to assist individuals in coming to terms with their experience (Cunico, 2001). This paper examines the current literature about NDE to answer the research questions:

  • (i)

    What is the prevalence of NDE in patients with serious illness or injury, or associated with a resuscitation event?

  • (ii)

    Is there a scientific explanation for the occurrence of NDE?

Section snippets

Method

To answer these questions, we aimed to explore the literature published in refereed journals between 2000 and 2010. This period was chosen to maintain the currency of evidence, given changes in medical technology over the last decade. Searches were made of electronic databases such as Medline Ovid, Cinahl Plus, PsychInfo, and PubMed for publications in English. Multiple searches were conducted with combinations of keywords that included: near death experience, out-of-body experience, paranormal

Prevalence of near death experiences

Several high quality studies have been conducted using representative samples with regard to the prevalence of NDE and details of these are presented below. Some studies have used a validated assessment scale such as the Near Death Experience Scale (NDE Scale) (Greyson, 1983) to determine whether a person has experienced a NDE.

The phenomenon is widespread within the community. A Gallup Poll in the USA in 1982 reported that 4% of the population had experienced a NDE (Gallup and Proctor, 1982). A

Conclusion

A ‘near death experience’ is a human response to danger that can occur with or without neurological impairment. Survivors of cardiac arrest and other individuals who have approached death have recalled numerous cognitive, affective or paranormal elements, although no underlying causative condition is known. Organic, chemically induced pathways in the brain have been postulated as inducing illusory perceptions of reality, including seeing bright lights and auditory noise. NDE appears to have a

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