"All humans engage in (spiritual thinking), so it's part of the human experience. How do we educate families to be open and supportive" of experiences with the dead? she asks. "How frustrating for a patient in the midst of this transition to try to talk to family members and be told they are nuts. Well-meaning families who are not prepared can damage their relationship they've worked so hard to develop with the loved one who is dying."

She's watched a huge interest in spirituality around death develop in the past few years, with "a big burst of interest in having spiritual care in nursing homes and hospitals. I think that's a result of people becoming more and more aware that we are spiritual beings."

Nationally, academic programs featuring classes on education about spirituality and death are on the increase, according to Jean Miller, professor of nursing at the University of Rhode Island. She has developed and taught courses on spirituality, loss and death for health professionals. A national initiative called the "End of Life Nursing Education Consortium" as been in place for about six years, focused on training nurses across the country.

"When working with these patients we're looking for their sources of hope — what gives them meaning and comfort, strength and peace. We're also looking for how their religion might help them, and if they have any personal spirituality or religious practices that would be important to observe."

She said such practices "began with Florence Nightingale" but have come in and out of vogue since then. "During my education in the '60s, it was not recognized so much — we were not supposed to talk about this. That was part of the emphasis on science and being very objective in what we observed and treated.

"Now we're realizing that good care is more than technology, more than medicines. There is something about loving care, about the spiritual. Some are uncomfortable with that in an academic setting. It just depends on their personal experience with it."

Miller taught courses in Sweden on the topic last summer, "and they are interested in it, but they have no words to put around it, because they don't go to church in Sweden. They're practically all Lutherans, but they only go there for baptism, weddings and funerals. But they're feeling the need to have this in their curriculum, yet they don't know how to put words on it."

When it comes to discussion of seeing deceased relatives or friends, "that happens," Miller said. "I don't know the real reason behind it. Some think it's a physiological reason, and others believe they really do see those people." She said the threat of a terminal diagnosis "often opens us up to thinking about really important things like our relationships — relationships to a higher being, to others and to ourselves.