The purpose of this study is to develop a management model to effectively provide hospice service of nursing home. In a method of study to achieve this purpose, a positive research and literature study have been performed at the same time. Concerning contents to be examined as a definition of notions and patterns about hospice for the aged, foreign hospice and structural elements of hospice management, a literature study to support a theoretical background has presented leading studies as an analysis form of this study through analyzing domestic and foreign literature, thesis, journal and so on. In order to attain the purpose of this study, the positive research is to carry out a survey of demand and desire of people who have already got hospice service in the first place as a fact-finding survey related to the subject of hospice service, investigate organizations to operate nursing home and hospice and relevant experts in the second place as a survey of supply system to provide hospice service, and develop an appropriate management model to connect the demand and supply of nursing home through it. Therefore, this study has developed a delivery system and a chart of the practical trend to be done minutely, presenting a model to manage a hospice of nursing home based on the above results. The management model externally has connected medical team of hospital with hospice team of home based on a community, and internally is composed centering on five elements such as administrative organization, manpower, program and contents of service, finances. In practical model of hospice management of nursing home, in order to plan a program, provide service and give a high-quality service to the aged, this study has presented a trend chart of service management on the basis of five structural elements, an analysis form of this study. In conclusion, this study could present data to develop a hospice in the field of nursing home for the aged by showing a model concerning a hospice management of nursing home, but in my opinion, a following study to be detailed and developed even more than this study should be continued.
Cancer is the second leading cause of the death in Korea. Family caregivers of dying patients manifest many psychological and physical symptoms of stress, and they often seek for informational support from health care providers. Unfortunately, however, few systematic studies identify the actual effect of such support on family caregivers. This study, thus, intends to evaluate the effect of informational support for hospice care. One group pretest-posttest design was used, employing the stress-coping model by Cohen and Wills as a conceptual framework. This research was conducted from July 1 to November 15, 1998, initially with 32 subjects sampled from hemato-oncology department of two general hospitals in Seoul, but reduced to 18 at the end due to the untimely death of patients or caregiver's refusal during the course of study. Informational supports were programmed to provide the family caregivers with 8 times of education and counseling as well as 24-hour hot-line for 4 weeks. A booklet that explains the various problems of hospice care was also prepared and distributed to all subjects. Data were collected by using self-report questionnaires and reviewing medical records. The tools used in this study were based on the Weinert's PRQ-II(scale of perceived social support), Spielberger's state anxiety inventory, and CES-D. Also included in the data collection were the general characteristics of family caregivers and patients, and the pain intensity and the performance status of patients. The data were analyzed with descriptive statistics, Wilcoxon sign rank test and paired t-test using SPSSWIN program. The results of the study were as follows: 1.The perceived social support of family caregivers was not significantly increased with informational support for hospice care(t=1.64, one tailed p=.060). 2.The anxiety of family caregivers was significantly reduced following informational support for hospice care(t=3.48, one tailed p=.002). 3.The depression of family caregivers was significantly reduced following informational support for hospice care(t=-2.18, one tailed=.022). 4.The pain intensity of patients with terminal cancer was significantly reduced following informational support for hospice care(t=-2.41, two tailed p=.027). The results suggest that the informational support provided to family caregivers of patients with terminal cancer reduced not only their anxiety and depression but also the pain intensity of patients. Further study is necessary to consolidate the conceptual framework of this study with expanded number of subjects. Nevertheless, it was certain that the informational support program for hospice care was very helpful to both caregivers and patients. Thus, the informational support program is strongly recommended for the hospitals which have no hospice unit yet.
This study was done to examine spiritual well-being of hospice care service volunteers for the purpose of providing them with programs promoting coping skills in response to the wholistic needs of patient effectively, also providing data for professional or nonprofessional hospice training program. Subjects were 123 volunteers serving in 6 hospice centers in Jeonbuk province at present. Data collection were done from 16 Oct. 2000 to 17 Nov. 2000. questionnairs were consisted of activities of hospice care service volunteer and spiritual well-being. The study results were as follows 1.Mean of activities of hospice care service volunteers were 2.433, those activities were divided into 5 categories such as spiritual, activities of volunteer for themselves, psychosocial, physical area and bereavement. The highest mean score was spiritual area 2.578, activities of volunteers for themselves 2.525, psychosocial area 2.456, physical area was 2.359 and the lowest mean score was bereavement area 2.130. 2.Spiritual well-being of hospice care service volunteers was 5.25, the highest mean. In subcategories of spiritual well-being, religious spiritual well-being was higher than existential spiritual well-being, mean score for each one was 5.41, 5.10. 3.Statistically significant relations among demographic characteristics such as gender(t=2.72, P=.008), status of marriage(t=6.067, P=.003), occupation(F=3.795, P=.025), frequency of visiting for volunteered hospice care(F=3.833, P=.024) were noted. 4.Statistically significant demographic characteristics of hospice service volunteers was religion(t=-4.38, p=0.000), status of marriage(F=3.505, p=0.033), frequency of visiting for volunteered hospice care(F=3.107, p=0.048), level of satisfaction from hospice care volunteer service(F=3.610, p=0.030), hospice service volunteers doing more home visiting(5-9times/month) had higher status of spiritual well being than volunteer with less home visiting(1-4times/month) 5.A significant relationship between activities of hospice service volunteers and status of spiritual well-being was noted(r=.236, p=.004), activities of hospice service volunteers was related to both subcategories of spiritual well-being such as religious well-being(r=.210, p=.010) and existential well-being(r=.208, p=.011). From the results of the study It is noted that status of spiritual well-being for hospice volunteers influences on service activities. It means spiritual well-being should be considered as a essential character for hospice service volunteers, it also means that managing and maintaining of status of spiritual well-being for hospice service volunteers is important. On the base of the study recommendation are made as follows: 1.Considering status of spiritual well-being for hospice care service volunteers is needed to promote hospice care activities. 2.It is necessary to develope spiritual well-being programs for hospice care service volunteers and further study for effect validation of them is needed. 3.Further study to sort out effecting variables for hospice care service volunteer activities is needed. 4.It will be desirable to have spiritual well-being information included in the hospice education program.
This paper constitutes a descriptive investigation and used a structured questionnaire to investigate nurses' and doctors' recognition of cancer patients. The subjects were extracted from the medical personnel working at the internal medicine, the surgery ward, the obstetrics and gynecology department, the pediatrics department, the cancer ward, and the emergency room of five general hospitals located in Seoul and Gyeonggi Province. The research lasted from August, 2001 to September 2001. Total 137 nurses and 65 doctors were included and made out the questionnaires directly distributed by the investigator. The study tool was also developed by the investigator and consisted of such items as the demographic and social characteristics, the medical personnel's recognition degree of cancer and cancer patients, their recognition of the management of cancer patients, and their participation in a hospice. The results were analyzed using the SPSS Window program in terms of technological statistics, ranks, t-test, and ANOVA. The reliability was represented in Cronbach' α=.75. The nurses' and doctors' recognition degree of cancer and cancer patients had an overall average of 3.86 at the 5 point-scale. The items that received an average of 4.0 or more included 'Medical personnel should explain about the cancer cure plans to the cancer patient and his or her family', 'A patient whose case has been diagnosed as a terminal cancer should be notified of it, 'If I were a cancer patient, I would want to get informed of it,' and 'Cancer shall be conquered whenever it is'. In the meantime, the items that received an average of 3.0 or less was 'My relationship with the cancer patient's family has gotten worse since I announced his or her impending death.' And according to the general characteristics and the difference test, the recognition degree of cancer and cancer patient was high among the subgroups of nurses, females, married persons, who were in their 30s, who had a family member that was a cancer patient, and who received a hospice education. The biggest number of the nurses and doctors saw 'a gradual approach over several days'(68.8%) as a method to tell a cancer patient about his or her cancer diagnosis or impending death. Those who usually tell tragic news were the physician in charge(62.8%), the family members or relatives(32.1%) and the clergymen(3.8%) in the order. The greatest number of them recommended a cancer patient's home as the place where he or she should face death because they thought 'it would stabilize his or her mentality'(91.9%) while a number of them recommended the hospital because they 'should give the psychological satisfaction to the patient'(40%) or 'should try their best until the last moment of the patient's death'(30%). A majority of the medical personnel regarded 'smoking or drinking' and 'diet' as the causes of cancer. The biggest symptom of a cancer patient was 'pain' and the pain management of a cancer patient was mostly impeded by the 'excessive fear of drug addiction, tolerance to drugs and side effects of drugs' by medical personnel, the patient, and his or her family. The most frequently adopted treatment plan of a terminal cancer patient was 'to do whatever the patient or his or her family wants' to resort to a hospice' and 'to continue active treatment efforts' in the order. The biggest reasons why a terminal cancer patient went to see a doctor were 'pain alleviation' 'control of symptoms other than pain(intravenous supply)' and 'incapability of the patient's family' in the order. Terminal cancer patients placed their major concern in 'spiritual(religious) matter' 'emotional matters' their family' 'existence' and 'physical matters' in the order. 113(58.5%) of the whole medical personnel answered they 'would recommend' an alternative treatment to a terminal cancer patient mostly because they assumed it would 'stabilize the patient's mentality.' Meanwhile, 80(41.5%) of them chose 'not to recommend it mostly due to the unverified effects and high cost of it(78.7%). A majority of them, I. e. 190(94.1%) subjects said they 'would recommend' a hospice to a terminal cancer patient mostly because they thought it would help the patient to 'mentally prepare'(66.6%) Only 17.3% of them, however, had received a hospice education, most of which was done through the hospital duty education(41.4%) and volunteer training(34.5%). The follows are results of this study: 1. The nurses and the doctors turned out to be still passive and experience confusion in dealing with a cancer patient despite their great sense of responsibility for him or her. 2.Nurses and Doctors realize the need of a hospice, but an extremely small number of them participate in a hospice education or performance. Thus, a whole recognition of a hospice should be changed, for which purpose a hospice education for nurses and doctors should be provided. 3.Terminal cancer patients preferred their home to a hospital as the place to face their impending death because they felt it would bring 'mental stability.' And most of nurses and doctors think it would be unnecessary for them to be hospitalized just for control of their symptoms. Accordingly a terminal cancer patient can be cared at home, and a home hospice care needs to be activated.
Prupose: The purpose of this study was to identify signs and symptoms of hospice patients during their dying processes. Method: The subjects of this study were 76 patients who received hospice care services in 2 different hospice care programs in Seoul area. Data was obtained from January, 1999 to June, 2001 by hospice nurse's observation, interviews with patient's primary caregiver and hospice volunteers, patient's self report, nursing records and questionnaires which had been developed by selecting from various references and refining them based on the result of preliminay studies. The collected data were analyzed with the SPSS PC+ program and content analysis. Results: Mean lengths of hospice patient's dying process were 3.6 days. Physical signs and symptoms of hospice patients during their dying processes were 'increased sleep'(89.5%), 'decreased oral intake of food'(88.2%) and 'liquids'(86.8%), 'change of respiration'(82.9%), 'decreased urine output'(80.3%), 'cold extremities'(69.7%), 'death rattle'(67.1%), 'cyanosis'(57.9%), 'restlessness'(55.3%), etc. And psychological, spiritual and social signs and symptoms were 'decreased interpersonal relationships'(61.8%), 'panorama of memories from childhood'(60.5%), 'experiences as like hallucination'(56.5%), 'saying bye with family'(69.7%), 'forgiveness', 'make a will', etc. Experiences as like hallucination were seemed not as dream but reality were shown by 43 dying patients. They had experienced to see and to talk with their deceased mother(18.6%) and/or relatives(30.2%), angels(20.9%), heaven(11.6%), old house in which they had lived, someone from the world beyond with black clothes, etc. Conclusion: The above results indicate that death of hospice patients is ongoing process with dying signs and symptoms during several days contains not only in physical aspects but also among psychological, spiritual and social aspects including family dynamics.
The hospice activities in Korea have still stood in the premature stage, although the contemporary hospice program, which professionally accommodates terminally ill patients, appeared in the history 35 years ago. Especially, the availability of the facility hospice is not only poor in number, but also lack of a guideline for the conduct of the facility. Saemmul Hospice has keenly felt the necessity of more facility hospices and has interchanged experiences and informations with people interested in hospice. However, the number of facilities has fallen short of one's expectations, and many problems have been revealed in order to maintain the operation. This paper was written in order to improve these atmospheres and to help more terminally ill cancer patients properly. This paper clarifies in detail the principle of management, the method of practice in each departments of Saemmul Hospice, expected effects and supplemental items. We try to provide concrete and practical informations and to help extensively for all peoples who are to begin or currently working. 1.Facility: It secures, maintain, and manage the hospice environment for all around care of patients effectively. 2.Education and Volunteer: It trains and manages hospice volunteers devoted to hospice. 3.Financial: It manages donation by healthy soul with an effective method. 4.Administration and Organization: It executes the administration efficiently and constitutes the organization to operate. 5.Medical and Nursing: It offers the maximum professional supports to a hospital. 6.Medicine and alternative medicine: It improves the quality of life of patients by medical and pharmaceutical approach and by other possible methods available. 7.Nutrition: It helps patients to have diets in accord with the order of the creation. 8.Belief: It offers spiritual care which allows the profound relationship with God. 9. Funeral ceremonies: Funeral ceremonies may heal grieves of families faced with their deaths. 10. Bereaved families: It supports the families after the deaths of patients. 11.Reception and consultation: It seeks to help the patients who meet the purposes for which Saemmul Hospice is established. 12.Publication: It allows publicity activities for Saemmul Hospice. Facility hospice programs are able to overcome the disadvantages that the other type of the hospice possess, like as the economic burdens of the families, and the patients' losses of comforts of home after being transferred to a hospital. Facility hospice can provide home atmosphere with professional manpower and facilities like hospital to the patients. Therefore, it can also improve patients' qualities of life and make them comfortable death. We anticipate that the hospice program in Korea would be more active to let more people be indebted to maintain the nobel human dignity and to cross beautifully in the most painful process of dying in the journey of their lives.
Childhood Cancer Foundation of ROC(CCFROC) has been founded since 1982. Its goal is to provide comprehensive care for cancer children and their families. And in turn, under the provision of good and complete care, they can be back to the school and society. To achieve this goal, it needs to get every body's effort of the society together. The foundation has been founder under this concept and tried to fulfil this task. The first step is to educate the public to know that childhood cancer can be cured and the process of treatment is long and expensive. In order to reach this life-saving procedure, campaigns for raising money is most important thing. Then, pediatric hematologists / oncologists try to organize study group, named Taiwan Pediatric Qncology Goupp(TPOG), to make treatment protocols for childhood cancers. Its primary purpose is to increase the cure rate to prove the earlier the diagnosis and treatment, the better the prognosis. The second step is to provide full support of medical expenses and further to give help for emergent need to living. Through the varieties of active exercises of cancer children or families, foundation provides opportunities for them to share the experience during the different periods of diseases. The third step is to extend the scope of training activities for many kinds of personnel who devote to the care for cancer children. On the other hand, it promotes the cooperation or communication with international organizations and sets up recreation playing ground in the communities. The aim is to provide a comprehensive and integrated care for cancer children during their education, breeding and even accomplishment period. Besides the financial support of medical care, it provides social services to give psychological support for children and their families, to strengthen doctor-patients or doctor-families relationship. The foundation provides the mourning religious activities to cherish the memory of their children who passed away and to comfort their sadness. Since the childhood cancer is curable, its treatment should be active, comprehensive and it needs to provide to all cancer children without exception. Indeed, the work of CCFROC should be changed according to the environment and different time period. But, it needs the full support from the society. We hope the scope and content of the work will be more extended and its achievement will be better than now in the future.
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