Formation of social work students for work with dying people and survivors

Formácia študentov sociálnej práce pre prácu so zomierajúcimi ľuďmi a pozostalými

Abstract:
Background: One of the target groups of social work is people in palliative and hospice care and survivors. However, no matter what social facility the social worker works in and with any target group, he may contact a client who has lost a loved one and is going through grief. Therefore, no matter how difficult death is, students of social work as a helping profession working with clients who have lost a loved one must manage this topic thoroughly.
Objectives: The paper aims to specify which subjects at the Faculty of Theology of the Catholic University focus on social work with the dying or survivors. Find out about social work students’ attitudes to death. Find out whether social work students tend to work with dying people or survivors.
Methodology: In the first part, we used the content analysis of study subjects from social work at the Faculty of Theology of the Catholic University in Ružomberok focused on social work with the dying or the survivors. In the second part, we researched with students of social work. In the research, we used a semi-structured interview and the “Cinquain” method.
Results: For students, the word death is often associated with terms such as fear, uncertainty, sadness, pain, trauma, suffering, loss of a loved one, abandonment, tragedy, end of a severe illness, end, transition to the next stage that everyone must undergo, stage of life, to which everyone gets once. In researching whether students are afraid of their death, we encountered answers such as perceptions of uncertainty about the course of death itself, fears of what they have not yet managed to do and what they would regret, whether feeling fear not of their death but also the death of their beloved person. Working with dying people would be depressing for many students and they would not be able to depersonalize; some said that it would depend on quite a bit on how the dying person would accept dying. More students tend to work with the survivors compared to working with the dying person. However, the students expressed their concerns about this service’s complexity due to the worker’s pain transfer and the unrealistic expectations that the social worker will somehow handle and manage the pain.
Conclusion: For some students, death is torturous, but in social work, it is a necessary topic. A separate space is devoted to it in the study subjects. Social work students are professionally prepared for social work with the dying and also with the survivors. However, the teacher should make this issue sensitive because each student may react differently to the topic of death. Open discussions are also appropriate where concerns about this issue can be addressed.
Key words: Death, Dying, Methods, Social work, Students, Survivor.

Abstrakt:
Východisko: Jednou z cieľových skupín sociálnej práce sú aj ľudia v paliatívnej a hospicovej starostlivosti, ako aj pozostalí. No sociálny pracovník nech by pracoval v ktoromkoľvek sociálnom zariadení a s akoukoľvek cieľovou skupinou, môže prísť do kontaktu s klientom, ktorý stratil niekoho z blízkych a prechádza trúchlením. Preto je nevyhnutné, nech je téma smrti akokoľvek náročná, aby študenti sociálnej práce ako pomáhajúcej profesie, zvládli prácu s klientmi, ktorí stratili blízkeho človeka.
Ciele: Cieľom príspevku je špecifikovať, ktoré predmety na Teologickej fakulte Katolíckej univerzity a ako obsahovo sa zameriavajú na sociálnu prácu so zomierajúcimi alebo pozostalými. Zistiť u študentov sociálnej práce ich postoj k smrti. Zistiť, či študenti sociálnej práce inklinujú k práci so zomierajúcimi ľuďmi alebo s pozostalými.
Metodika: V prvej časti sme využili obsahovú analýzu študijných predmetov zo sociálnej práce na Teologickej fakulty Katolíckej univerzity v Ružomberku zameraných na sociálnu prácu so zomierajúcimi alebo s pozostalými. V druhej časti sme zrealizovali výskum so študentmi sociálnej práce. V rámci výskumu sme využili pološtruktúrované interview a metódu „Cinquain“.
Výsledky: Študentom sa slovo smrť často spája s pojmami ako strach, neistota, smútok, bolesť, trauma, trápenie sa, strata milovanej osoby, opustenosť, tragédia, ukončenie ťažkej choroby, koniec, prechod do ďalšej etapy, ktorý musí každý podstúpiť, etapa života, do ktorej sa raz každý dostane. Pri zisťovaní, či študenti majú strach z vlastnej smrti, tak sme sa stretli s odpoveďami ako vnímanie neistoty zo samotného priebehu smrti, obáv z toho, čo ešte nestihli urobiť a čo by ľutovali, či pociťovanie strachu ani nie z vlastnej smrti, ale zo smrti milovaného človeka. Práca so zomierajúcimi ľuďmi by pre viacerých študentov pôsobila depresívne a nedokázali by sa odosobniť, niektorí sa vyjadrili, že by dosť záviselo od toho, že ako by zomieranie prijal samotný zomierajúci. K práci s pozostalými inklinuje viac študentov v porovnaní s prácou so zomierajúcimi. Avšak študenti vyjadrili svoje obavy o náročnosti tejto služby, kvôli presunutiu bolesti na pracovníka a aj vzhľadom na nereálne očakávania, že sociálny pracovník nejakým spôsobom za nich spracuje bolesť.
Závery: Pre niektorých študentov je téma smrti náročná, avšak v sociálnej práci je to nevyhnutná téma. V študijných predmetoch je jej venovaná samostatná oblasť. Študenti sociálnej práce sú odborne pripravovaní na sociálnu prácu so zomierajúcimi a aj s pozostalými. Pedagóg by však mal túto problematiku predostrieť citlivo, lebo každý študent môže rozdielne reagovať na tému smrti. Vhodné sú aj otvorené diskusie, kde sa môžu spracovať obavy z tejto problematiky.
Kľúčové slová: Smrť, Zomierajúci, Metódy, Sociálna práca, Študenti, Pozostalý.

Introduction

Death as an absolute and inevitable reality confronts one with the limits of one‘s possibilities. Social work with the dying or survivors can be a source of anxiety, fear and helplessness for a social worker. He can perceive the survivor's pain, which creates fear for his loved ones and his own life. To guide both the dying and the survivor well and safely, we must see death as part of life. The social worker should be ready and willing to listen and talk about death. Do not divert to other topics of the one who opens the conversation, but stay present and help with the opening of pain and repressed emotions and thoughts (Vodáčková et al, 2012, pp. 305-307). As stated by Nová, one asks the meaning of life, seeks answers to questions such as “What comes after death? Is there life after death”, is interested in supernatural phenomena, and can explain them by powerful invisible forces. One also has its way of expressing the religious dimension, for example, neutrally or negatively (Nová, 2017a, p. 176).

Current ideas of death in the general population could be divided into four types: death as the end of life (In people with this attitude, death is the end of life, which they state soberly and vividly. Some refer to it as the natural culmination of life.) or destiny and vis mayor (In this way, many people look at death in resignation. It is experienced as the power that decides - there is magic, but also distance and darkness, with no escape.), death as redemption (This attitude characterizes the view of death as a liberation from the pain and suffering of life on Earth and, on the one hand, as a transition to a new life. This view presents hope beyond death.) and death as fear (Death is considered to be cruel and threatening) (Pompey, 2004,).

The general attitude of death has three essential components, particularly the emotional relationship to death (This is usually expressed by fear and anxiety, more rarely by some other emotion - it can be apathy and resignation, but also desire. Evaluating death as something desirable is not common in significantly older people; such an attitude may arise in connection with the need to get rid of excessive suffering or as a result of an entirely negative balance and an unfavorable perspective.), cognitive component (Attitude to death includes knowledge of dying and one’s own experience of death. This is minimal in most cases. People do not value a similar experience and do not have many opportunities to gain it. This way of defense - escape from the problem ultimately leads to an emotional evaluation over the rational. People do not want to talk about death unless they are old. After that, their attitude usually changes.) and behavior (This is usually influenced mainly emotionally. Concerning death or dying people, a person behaves in such a way to avoid confrontation with this component of reality, either in fact or symbolically) (Vágnerová, 2007, p. 430).

The general goal of social work with people who have lost a loved one is to help the survivor adapt to the loss of a loved one and adapt to the new reality without the deceased. Specific goals include helping the survivor accept the reality of loss, helping him deal with emotional and behavioral pain, helping him overcome various barriers to adjusting to loss, and helping him find a way to bond with the deceased so he can reinvest in life (Worden, 2008, pp. 40-43).

A social worker can meet people immediately after someone close to them has died. Especially when it comes to tragic and sudden death, survivors often hope that it is just a nightmare from which they could wake up. Another group of clients may be survivors who did not process the loss of a loved one expectedly, suppressed the pain because they did not have the strength to accept it. Their problem remained unresolved and often, the hidden crisis manifests itself in psychosomatic problems. The real trigger for the crisis - the loss - remains hidden. It is sometimes difficult, sometimes impossible, for these people to reach the crisis’s real source. However, this is necessary to solve the problem. A social worker may meet people who have died, but they pretend not to have died. They refuse to accept reality. They keep in touch with the deceased, talk to him like he exists, pretend to be with them in real life. The reason is sometimes that the survivors lacked the final ritual - funeral. Someone does not bear the funeral because he would not be able to go through it and would not have enough strength. If this has already happened, it is essential to say goodbye to the deceased somehow. For example, in a family circle that meets to remember and say goodbye, at a funeral mass, or entirely privately when the survivor goes to the place where he used to go with the deceased, and there he can light a candle or have a quiet moment. If this does not help, the survivor may need more support and encouragement to turn to the living people’s world, which has ceased to be attractive to him or become threatening (Vodáčková et al, 2012, pp. 306-311).

Methodology of research

We set three goals, particularly 1. To specify which subjects and how content focuses on social work with the dying or survivors. 2. To find out the attitude to death among social work students. 3. Find out whether social work students tend to work with dying people or survivors.

In the first part, we used the content analysis of study subjects from social work at the Faculty of Theology of the Catholic University in Ružomberok focused on social work with the dying or the survivors. We focused on specific topics that address the issue of the dying and survivors.

In the second part, we conducted research with students of social work. As part of the research, we used a semi-structured interview with set research questions: What comes to your mind at first with the word death? Are you afraid of your death? Can you imagine working with dying people (e.g., in a hospice)? Can you imagine working with survivors (e.g., as part of mourning counseling)? Another method used was the “Cinquain” (five verses), where the first verse forms the given noun (in our case, the word “death”), then students had to write 2 nouns that, according to them, describe the given word, followed by 3 verbs that describe the given word, then 4 words describing their relationship to the word and finally below it 1 noun, which is a synonym of the initial word.
The research group consisted of social work students at the Faculty of Theology of the Catholic University in Ružomberok.

Preparing students to work with the dying and the survivors
One of the target groups of social work is people in palliative and hospice care and survivors. It does not matter the social facility the social worker works in and with any target group, he may come into contact with a client who has lost a loved one and is undergoing grief. Therefore, no matter how difficult the topic of death is, students of social work as a helping profession should know how to work with clients who have lost a loved one.
According to Špatenková (2013,), a worker helping survivors should have specific practical, professional and personal competencies. An essential requirement is that the social worker is balanced with his mortality; he should be aware of his losses and reactions to situations and topics of death, dying and grief.
At the Faculty of Theology of the Catholic University in Ružomberok, we have subjects that address the dying and the survivors' issues.
In the bachelor’s studies degree, it is the subject “Social work with people with disabilities and the elderly”, in which palliative and hospice care are separately focused on topics such as:

• palliative medicine, hospice care, terminally ill person, dying,
• stages of illness acceptance,
• palliative care: goals, content, tasks, forms,
• hospice: definition, principles, forms,
• comprehensive terminal care.

In the master’s degree, it is a subject “Methods and techniques of social work”, in which social work with survivors is also focused on topics such as:

• goals of social work with survivors,
• mourning process,
• normal and complicated grief,
• behavior towards survivors,
• methods and techniques of social work with survivors: evocative language, metaphors, an empty chair, direct image, visit the cemetery, writing, unwritten sentences, drawing, family board, the book of memories, a box of memories, cognitive restructuring, circular questions, list of meaningful things, meetings providing courage, spiritual reading, prayer, mourning cafe, self-help groups,
• specific losses. .

Methods of guiding the dying person

We introduce students to the process of guiding the dying person and its essential principles and methods.

• presence
  The most important care is the “friendly presence” with the dying person. An attentive and caring presence strengthens hope and trust in the sick and helps him cope with death. It is a unique contribution that employees can make to the dying person with their human presence even more than their professional activity. Such an approach leads to the fact that in the patient, the rejection is replaced by acceptance and hope prevails over fear (Ďačok, 2000, p. 136).
• silence
  One turns inward and has less need to talk. Sometimes words lose their meaning and being quiet is more meaningful. When the guiding person enters the silent participation, he can know the healing power of silence (Hospice civic association Cesta domů, 2013, pp. 5-10).
• communication
  The dying person loses track of time, sometimes not recognizing the person present, which can be painful. However, it is essential to realize that this is not a rejection, but that the dying person is losing touch with our reality. It also happens that he speaks to God or about events and people we do not know. Sometimes he sees people who have already died and talks to them; he feels taken by them. It is important not to blame him for his reality or to drive him away from those evaluating them as hallucinations, but to get involved in his world, where we listen carefully and thus learn something from him.
  The difficult task of the guiding person is not to take the temptation to decide for the patient. We want to protect him, e.g., before the correct information about his illness and that death is getting closer. Let us not be mistaken; no matter what questions he asks, he wants to know the truth and does not want to be deceived by those around him. Let us listen to his quiet, timid and sometimes very indirect questions and hide nothing. Answer the questions truthfully and without evasive answers. A person who is at the end of his life usually knows this fact very well, and if we pretend that this is not true and he will still be “another 20 years here”, then we throw him into loneliness, he prevents further communication and to cope with death, he will stay completely alone. Our task is to guide him on the last part of the journey, support him. Do not put any false hopes, no matter how cheerfully we intend to sound. Now is not the time to dream for each other, but to truly walk together and survive the remaining moments.
  Some people fall into a coma in recent days. From the many testimonies of clinically dead people and returned to life, we know that a person, even if not conscious, hears everything. Hearing is the last sense that disappears. Therefore, we speak in the presence of a dying person as if we were talking to him or close by him as if he is conscious. Although he looks deep unconscious, he may hear everything being said around him. Let us motivate his beloved ones to tell him what they have not told him or what they want him to know. By no means is it too late to say forgive me or I love you or whatever they always wanted to say. It is not appropriate to ask, blame or beg him not to die (Hospice civic association Cesta domů, 2013, pp. 5-10).
• prayer
  Illness could become a period of special prayer, understood as seeking a lasting deeper connection with God. A patient in the terminal stage can express his gratitude to God for everything he has received in his life so far. However, he can also express all his fears, anxieties and rebellions before imminent death. Prayer can help overcome each of these tense situations, which strengthens peace, deepens trust and strengthens hope (Ďačok, 2000,).
  When a person dies, it is also essential to meet spiritual needs that can explain to people the secret of human existence. Religion plays a vital role in dying and death matters, as it has a significant influence on human’s ideas about death itself and what comes after it (Nová, 2017b, p. 189).
• saying goodbye
  Death comes near and is reported differently. Sometimes a dying person tells us that he thought he was dead. Sometimes he asks us urgently if he is alive or dead. This is all normal. One of the relatively common manifestations is the “suitcase packaging”. It is manifested with the sometimes even enforced desire to leave, the specific need to pack up for the journey, to end things in progress. We should help close open issues in such moments, end relationships, and say goodbye. Sometimes a dying person needs his loved ones to release him, to let him go. Let them support the dying person, let them tell him that they love him, ask for forgiveness, forgive him.
  Moreover, they should not be afraid to tell him that they are not holding him back, that he can leave. It is sometimes very painful, but the person often expects reassurance from loved ones that they will manage even without him. Farewell can bring peace to both the dying person and his family. A dying person often calms down and then leaves more in peace (Hospice Civic Association Cesta domů, 2013, pp. 5-10).

Methods of social work with the survivors

Social work students are introduced to specific methods for working with clients experiencing a loved one's loss.

• evocative language
  A social worker can evoke feelings through words, e.g., “Your son has died,” “Your husband is dead.”, etc. It is necessary to speak in the past tense. Language helps to present the reality of loss. It also stimulates painful emotions that survivors need to survive (Špatenková, 2008, p. 76).
• using metaphors
  Metaphors as visual aids are used to reduce resistance to the pain of grief when the survivor cannot directly confront the feelings associated with death. Metaphors offer a more acceptable symbolic representation through which the survivor can express feelings. Thus, the survivor will focus on an illustrative image symbolizing his experience in a more acceptable and less painful form. A social worker can use metaphors such as “valley of tears”, “climbing a mountain”, the hole for the client to fall into, “the trap he was caught in”, the image of “amputation”, etc. (Špatenková, 2008, p. 76; Worden 2008, p. 93).
• empty chair
  It is essential that survivors speak directly to the deceased in the present tense, not just talk about him. Talking to someone has a more significant effect than talking about him. The social worker places an empty chair in front of the survivor and imagines that the deceased sits on a chair. Then the survivor talks about his thoughts and feelings regarding the death and his relationship directly to the deceased. We can emphasize the effectiveness by letting the survivor swap the empty and his chair and speak for the deceased and himself (Worden, 2008, p. 152). This method is also suitable for mothers who got the abort their child.
• visiting cemetery
  Social workers can advise the survivor to go to the cemetery and speak to their loved ones. Let him share everything. Perhaps the survivor was unable and unwilling to communicate with others while living. So now he can express everything. Like this, he can share everything with the deceased person, therefore release injuries and anger faster and easier (Padovani, 2014, p. 154).
• memory book
  The book can contain photographs, stories of family events, children’s drawings, letters, etc. The survivor can return to the book at any time and relive the memories (Špatenková, 2008, p. 80).
• box of memories
  The client creates a box to store objects associated with the deceased, e.g., clothes, toys, etc. These objects remind the survivor of the deceased. At first, looking at these things can depress a survivor and he may consider throwing everything away. However, it is better to wait. He had better put everything aside but do not get rid of it forever. Because one day, he could want to return to it. Maybe one day, he will appreciate these little things and be glad to keep them. They remind a loved one to find them comforting and aware of being close to a loved one (Grollman, 2016, pp. 135-136; Špatenková, 2008, p. 80).
• writing
  It helps some survivors to write down their thoughts and feelings as they feel it into a diary during mourning. They can write a letter to the deceased expressing their thoughts and feelings. Thus, the survivor can share his grief and pain on paper or a computer. He can write anything he did not have time to share with the deceased. He can open things remaining unresolved between them. They can also write poems or fiction (Špatenková, 2008, p. 77).
• unfinished sentences
  The social worker presents sentences to the survivor and the client’s role is to answer or complete the submitted sentences spontaneously. Hidden emotions, thoughts or wishes can be revealed to the client. Examples of unwritten sentences: When I hear your name, then ... I remember the last time we were together ... Since the moment of your death, my life is ... I always wanted to ask you ... I am sad for ... I wish I could ... I wish you would... My friends do not understand that ... I am angry because ... If at all ... I am relieved that .... It is hard for me to forgive ... the moment you died ... It scares me the most ... When I think of you, I always remember ... If you lived, then ... I wish the most ... I will always remember this experience of ours together. .. etc. (Grollman, 2016, p. 146).
• drawing
  The suitable technique, especially for mourning children, but also for the whole family. The assignment may be, for example: Draw a family before and after XY died. Members can draw together or separately and then compare the drawings. The benefits include facilitating feelings, increasing awareness of loss, and promoting communication about the changes that have taken place in the family after the death of a loved one (Worden, 2008, p. 94; Špatenková, 2008, p. 78).
• cognitive resctructuralization
  Hidden thoughts and internal conversations take place in people’s minds. Survivors often say, “He was all to me.” “Without him, my life has no meaning.” “No one will like me anymore.” Survivors need to examine their thought constructions and belief systems, often negative or neurotic. The social worker helps the survivor identify such ideas and test their truthfulness with reality (Padovani, 2014, p. 150; Worden, 2008, p. 95).
• list of meaningful things
  A social worker can motivate a survivor not to think so much about what he has lost but to focus on what he or she has. Have the survivor try to write a list of all the good that remains in his life. It is clear that compared to the enormous loss, these things may seem insignificant. Nevertheless, even though one is very sad, there are still meaningful things to think about and strive for. Living further means acknowledging that we cannot change the reality of death. Living on does not mean feeling any more pain, but taking every day as it comes and experiencing it as best you can. Living further means paying tribute to the life of a loved one (Grollman, 2016, pp. 134-135).
  The social worker leads the survivor sensitively and slowly to such a view of the world, where, despite all the negative things that have happened, the positive values remain still present (even if the extremely positive value has is gone).
• mourning cafe
  A social worker can organize a mourning café as an activity with mourning being discussed. The topic will be shared with the public, e.g., through the media and those interested, listen to the lecture and then discuss over coffee. Further, individual interviews or creative techniques can continue (Masarik et al, 2014, p. 28).
• prayer
  A prayer is a form of dialogue with God; it encounters God and strengthens the human. Believers are helped by their prayer, but also when others pray for them or with them. Thanksgiving helps because the survivor thinks about the positives (Pontifical Council for the Family, 2006, pp. 21-22; Lyko and Lehoczká, 2009, p. 40; Špatenková, 2008, p. 82).
• self-helping groups
  Self-helping groups are based on mutual voluntary help and support. Their origin is often based on people interested in solving their problems and other people going through the same problem (Šik, 2008,). Self-helping groups' goal is mainly mutual support in coping with a similar life situation or solving a similar problem. This is achieved through direct interactions, mutual help, emotional support, sharing experiences, or direct help between members sharing the same problem. Members meet on a voluntary and democratic basis in a group, without professional guidance (Balogová et al, 2017,).
  Members of these groups also suffered similarly. A person who has experienced a similar loss can provide significant help. The role of these groups is to share feelings, reactions, problems and provide mutual understanding. The finding that other people also survived a similar loss and managed to manage it in some way gives survivors the hope that they will once again reach such a phase (Martinez and Hullová, 2007, pp. 73-74; Špatenková, 2008, p. 47).

Attitudes of social work students towards the death

As part of the mentioned subjects before the very topic of death, we first discuss this topic with the students, where I find out what their attitude to death is so that I can then adapt the lectures appropriately. Whether the death of clients or helping survivors cannot be avoided, the topic of death cannot be avoided, but it can be applied mentally more carefully or supplemented with what students currently need. The social worker should have personally processed this topic to be able to cope with it for and with the client.

In finding out what students think first of the word death, we came across answers like:

• fear,
• uncertainty,
• sadness,
• anxiety,
• hopelessness,
• panic,
• pain,
• trauma,
• suffering,
• loss of meaning in life,
• loss of someone we loved,
• abandonment,
• tragedy,
• the end of a severe illness, because often life ends after a severe illness, it is then considered to be a redemption,
• end,
• transition to the next stage, which everyone must undergo,
• a part of life, development, a course into which everyone gets once.

Fear was a prevalent emotion. Homolová (2009, p. 329) writes about the fear of death that “our fear of death is an important cause that makes it so difficult for us to help the dying and survivors. We try to make it look nicer, avoid the facts of death by using euphemisms, and protect ourselves very often if we do not leave children at funeral ceremonies look at a dead body. Our hectic lifestyle causes the fear of death to be suppressed. We think we are living fast, so we will get more from this short life.”

When I asked the students if they were afraid of their death, their answers included:

• Uncertainty about the course of their deaths, how the last minutes will “look,” and what will happen next.
• Instead, trying to displace suffering and thoughts of death because they seem daunting. Similarly, Yalom (2006, p. 52) states that “the horror that death is everywhere around us and so results in one spending much of one’s life energy to deny death.”
• Fear not even of our death, but of the death of a loved one, whom we love that we will lose him and how we will live without him, in other words, that when we are dead, nothing will bother us anymore, but when our beloved person dies, it is a great pain to deal with.
• Concerns about the grief of loved ones over their deaths were also present. Some claimed that they were afraid to die so as not to cause pain to their parents. Similarly, Yalom (2006, p. 53) cites research conducted with nearly six hundred respondents, where they were to prioritize several consequences of death. The most common death concerns were, in descending order of frequency: 1. Unfortunately, my death will cause my relatives and friends great pain. 2. All my plans and projects will end. 3. The dying process can be painful. 4. I will no longer be able to experience anything. 5. I will no longer be able to care for those who depend on me. 6. I am afraid of what might happen to me if there is life after death. 7. I am afraid of what might happen to my body after death.
• Sometimes it is difficult to open the topic of death, especially if it is the moment when students realize that they have, e.g., elderly parents or someone very seriously ill in the family, and are not yet ready to accept the reality of approaching death.
• There is also a present fear of what we would not do by the time of death, what we would regret that we did or did not do.
• When thinking of death, some comes with the idea of trying to live the best possible life, build amicable relationships, enjoy the little details and enjoy life.
• The effort to find the meaning of life that would be beneficial not only for the person himself but also for his surroundings, not to be afraid to open up to help from the others while there is still time.
• For believers, death is sometimes easier to accept because they do not see it as a finality but as a transition to eternal life, where they will also meet their beloved dead relatives. For many, this aspect of faith helps to overcome the fear of death and the death of loved ones. Homolová (2009, p. 329) presents research confirming that the subjects showed that they expect religion to deal with death, soothing pain, and finally hope for the afterlife. It is clear, then, that faith in God is at least seen as an aid and also as the foundation of the trust needed to cope with dying.

When I find out from students whether they could imagine working with dying people, e.g., in a hospice, the answers are also different:

• Students who are afraid to think about their death would not imagine working with a person who needs to talk about their moment of death. They would not be able to do it mentally or professionally. A publication published by one hospice (Spolok Samaritán, 1998, p. 9) states that “It is necessary for those interested in working in a hospice to be balanced and reconciled with their mortality. It is important to have the ability to empathize (the ability to feel into the other’s feelings). This ability may be partially innate but can be developed gradually. The hospice is trying to avoid a paternalistic approach to the sick and replace it with a partnership. In principle, the directive approach to the patient is not used.”
• For some, this work would be depressing; they would not be able to depersonalize. According to Čechová (2004,), “we experience a confrontation with death as traumatic because the death of another person reminds us that even our life is limited in time, it can end at any time.”
• Some said that it would depend a lot on how a particular person manages to die and experiences the client’s attitude towards impending death approaching.
• In turn, some realize that if a client were to “be too close to their heart,” it would be more challenging.
• Some said that most if they were to help dying children, they would find it difficult to bear and solve a kind of injustice to why children die, as they still have a life ahead of them. Moreover, there were also concerns about whether they could bear the pain of their parents. Kuzníková (2011,) states that a child's death is a great suffering for his close relatives, especially for parents. At this moment, the social worker should show humanity, empathy, the art of guiding, be the person who will help to accept and survive the death of the child with everything that belongs to it. The most significant pain belongs to the parents. It is necessary to talk to parents, but also dying children, to answer questions truthfully. Do not lie at all. A child can also ask about death. Given his age, it is necessary to tell him the truth in cooperation with his parents and prepare him „to leave“. When a child dies, we should not forget about him or her. At that moment, it is the child to be the center of our care. The pain of the parents must not be the pain of the child. The child perceives us and needs our real support.
• There were also concerns about whether they had done everything they could for the dying client, whether they had neglected something, or whether they should not have spent more time with him in his last moments. In her research, Urbanová (2015, p. 57) found out what is absent for supporting workers for the dying person's quality guiding. The most frequent answer was that they lacked enough time for the dying person (55%) and another lacked training (24%). To a lesser extent, it was literature (6%), employer support (6%), colleague support (5%), proper communication with colleagues (1%) and supervision (1%).

On the other hand, I research if they could imagine working with survivors. Interestingly, most students say that they would work with the dying rather than the survivors.

• Some said that working with survivors would be psychologically very demanding and exhausting, as the survivor seems to transmit or load his or her pain to the social worker, and the social worker must be prepared to bear the pain and be able to depersonalize.
• They also fear that the survivors would have disproportionate expectations from the social worker's help and that they would expect the social worker to somehow treat the pain for them, which they cannot process.
• Some are concerned that they might not be able to correct the psychological manifestations of the client’s grief that when the person opens to the grief, it shows the feelings of pain accompanied by crying towards the others, or whether that they could guide the client properly so as not to harm the client. Instead, they said they would be afraid to open up the grief of the client.
• Students who have difficulty accepting their death and are afraid of it have said that they would not be able to support others in the process of mourning death until they could handle their fear of death themselves.

Conclusion

For some people, death is torturous, but in social work, it is a necessary topic. Therefore, a separate space is devoted to it in the study subjects. Social work students are professionally prepared for social work with the dying and also with the survivors. They acquire specific methods of social work with survivors, as well as leading the mourning process.

However, what we perceive as necessary is the sensitivity and caution of introducing this topic. Each student can react differently to the topic of death. For some, this can be a neutral topic and takes it as expertise that he must go through. For others, however, it can be a very personal topic, needed to be processed mentally. Therefore, open discussions are also appropriate, where concerns about this issue can be safely addressed.

Author: PhDr. Michaela Šuľová, PhD.
Catholic University in Ružomberok, Faculty of Theology, Department of Social Sciences

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