• Journal of Korean Academy of Nursing
• /
• v.28 no.4
• /
• pp.958-969
• /
• 1998

In this study, we attempted to investigate the needs and problems of the terminal cancer patients and their family caregivers to provide them with nursing information to improve their quality of life and prepare for a peaceful death. Data was collected from August 1, 1995 to July 31, 1996 at the internal medicine unit of S hospital in Seoul area with the two groups of participants who were family members of terminal cancer patients seventy four of them were in-patients and 34 were out-patients who were discharged from the same hospital for home care. The research tool used in this study has been developed by selecting the questionnaires from various references, modifying them for our purpose and refining them based on the results of preliminary study. While general background information about the patients was obtained by reviewing their medical records, all other information was collected by interviewing the primary family caregivers of the patients using the questionnaire. The data collected were analyzed with the SPSS PC/sup +/ program. The results of this study are summarized as follows ; 1) Most frequently complained symptoms of the terminal cancer patients were in the order of pain(87%), weakness(86.1%), anorexia(83.3%) and fatigue (80.6%). 2) Main therapies for the terminal cancer patients were pain control (58.3%), hyperalimentation(47.2%) and antibiotics(21.3%). 3) Special medical devices that terminal cancer patients used most were oxygen device (11.1%), and feeding tube(5.6%). Other devices were used by less than 5% of the patients. 4) The mobility of 70.4% of the patients was worse than ECOG 3 level, they had to stay in bed more than 50% of a day. 5) Patients wanted their medical staffs to help relieve pain(45.4%), various physical symptoms(29.6%), and problems associated with their emotion(11.1%). 6) 16.7% of the family caregivers hoped for full recovery of the patients, refusing to admit the status of the patients. Also, 37% wished for the extension of the patient's life at least for 6 months. 7) Only 38.9% of the family members was preparing for the patient's funeral. 8) 45.4% of family caregivers prefer hospital as the place for the patient's death, 39.8% their own home, and 14.8% undetermined. 9) Caregivers of the patients were mostly close family members, i.e., spouse(62%), and sons and daughters or daughter-in-laws(21.3%). 10) 43.5% of the family caregivers were aware of hospice care. 46.8% of them learned about the hospice care from the mass media, 27.7% from health professionals, and the rest from books and other sources. 11) Caregivers were asked about the most difficult problems they encounter in home care, 41 of them pointed out the lack of health professionals they can contact, counsel and get help from in case of emergency, 17 identified the difficulty of finding appropriate transportation to hospital, and 13 stated the difficulty of admission in hospital as needed. 12) 93.6% of family caregivers demanded 24-hour hot line, 80% the visiting nurses and doctors, and 69.4% the volunteer's help. The above results indicate that terminal patients and their family caregivers demand help from qualified health professionals whenever necessary. Hospice care system led by well-trained medical and nursing staffs is one of the viable answers for such demands.

• The Journal of Korean Academic Society of Nursing Education
• /
• v.5 no.2
• /
• pp.376-387
• /
• 1999

Purpose : To provide fundamental data to present further direction of education on Nursing Ethics by investigating the status of Nursing Ethics education performed at 4-year-Colleges of Nursing. Korea. Methods : A descriptive survey study The data collected from 28 universities through a questionnaire to examine the status of Nursing Ethics education in Korea. Results : I. Teaching Nursing Ethics class as a independent subject-6(21.4%) universities. 1) The average of 23.67 hours(2 credits) in the total educational hours. 2) Teaching method-theoretical class, discussion of case study, discussion of related issues, presentation of video tapes and discussion, team education, role play, and submission of reports. 3) Education contents-Nursing profession and ethics, the dignity of human life, necessity of bioethics, ethical theory and refutation, code for nurses, ethical issues between nurses and patients, nurses and co-workers, and nurses and nurses 6 universities 4) 5 universities-Included ethical decision making, artificial insemination, external insemination, artificial abortion, organ transplantation, brain death, human subject of study suicide, and euthanasia. II. Teaching Nursing Ethics as an inclusive theme in other subjects-22 (78.57%) universities. 1) Educated in Introduction of Nursing (14 universities), Nursing Management, Nursing Ethics and Philosophy, Special Nursing, Nursing and Law, and Professional Nursing. 2) Educational course-Taught in freshman level at 14 universities, average 9.32 education hours. Conclusion: Showed not only that universities, not operating Nursing Ethics as a independent class, unreasonably operate and assign too many contents in comparing with its education hours and are likely to become only a cramming education but also professors whose major is not Nursing Ethics presently in charge need to take a chance to supplement their knowledge and teaching method.

• Childhood Kidney Diseases
• /
• v.3 no.1
• /
• pp.72-79
• /
• 1999

Renal scarring associated with vesico-ureteral reflux(VUR) is one of the major causes of end stage renal failure and renal hypertension in children. Urinary ${\beta}_2$-microglobulin(MG) has been suggested as a potential marker for presence of renal tubular damage. This study was designed to evaluate the significance of random urine ${\beta}_2$-MG as a predictor of presence of vesico-ureteral reflux in children with urinary tract infection(UTI). 57 children with urinary tract infection were studied. Patients were devided into two groups; 35($78.9\%$) children have UTI without VUR and 12($21.1\%$) children have UTI and VUR. Beta2-MG and creatinine in random urine sample was measured to decide the excretion ratio(${\beta}_2$-MG/creatinine). Among the 57 children with UTI, 44 children were confirmed by urine culture study and 13 children suspected by compatible clinical feature. Random urine ${\beta}_2$-MG of VUR group ($2.2{\pm}5.91$ mg/L) were significantly higher than that of simple UTI group($0.19{\pm}0.16mg/L$)(P=0.03). The ${\beta}_2$-MG/creatinine ratio of VUR group($32.41{\pm}25.7$) were significantly higher than that of simple UTI group($3.93{\pm}3.44$)(P=0.007). In conclusion, random urine ${\beta}_2$-MG and excretion ratio deserved early predictor of presence of VUR in children with UTI. And this method was more simple and inexpensive than the method of measuring ${\beta}_2$-MG with 24 hour urine collection, so might be a useful screening test for VUR in children with UTI.

• Journal of Korean Academy of Nursing
• /
• v.25 no.3
• /
• pp.510-537
• /
• 1995

Human health is an integral part of experience in the process of Human Becoming. Through continual interaction with the environment human beings freely choose experience and develop as responsible beings. The process of the health experience of patient with terminal cancer is a unique. he objective of this study is to understand the lived experience of patients with terminal cancer in order to provide basic information for nursing care in the clinical setting and to develop a theoretical background for clinical practice. This study is to de-scribe and define the lived experience of patients with terminal cancer in order to provide a foundation for nursing research and education. Data collection has been done between December 1993 and November 1994. The subjects included five persons -four females and one male : one who was in her sixties, one in his fifties, two in their forties, and one who was in her thirties. The researcher has met with these patients 35 times, but at eight times the patient was in a stuporous condition and not able to participate, so these were not included in the data analysis. Parse's "Human Becoming Methodology", an existential phenomenological research methodology is used for this study. Data has been collected using he dialogical engagement process of "I and You", the participant researcher and the participant subject. Dialogical engagement was discontinued when the data was theoretically saturated. Data was analyzed using the extraction - synthesis and heuristic interpretation. The criteria of Guba and Lincoln(1985). and Sandelo wski(1986) : credibility, auditability, fitness and objectivity were used to test the validity and reliability of the data. The following is a description of the structure of the lived experience of patients with terminal cancer as defined by this study : 1. Structure : 1) Suffering through the reminiscence of past experience 2) The appearance of complex emotions related to life and connectedness 3) The increasing importance of significant people and of the Absolute Being 4) The increasing realization of the importance of health and belief 5) Desire for a return to health and a peaceful life or for acceptance of dying and a comfortable death In summary the structure of the lived experience of these patients can be said to be : suffering comes through reminiscence of past experience, and there are complex emotions related to life and connectedness. Significant people and the Absolute Being become increasingly important along with a realization of the importance of health and faith. And finally there is a desire for either a return to health and a peaceful life or for the acceptance of dying and a comfortable death. 2. Heuristic Interpretation : Using Parse's Human Becoming Methodology, the structure of the lived experience of patients with terminal cancer identified in this research is interpreted as. The lived experience of patients with terminal cancer involves the solving of past conflicts, and the experience of the healing and valuing of sorrow and pain. Through the relation of life and health, and the complex emotions that arise, the lived experience of revealing - concealing is of paradoxical emotions. The increasing importance of significant others and of the Absolute Being shows Connecting and Separating an on- going process of nearness and farness. Revision of thoughts about health and faith is interpreted as transforming and desire for restoration to health and a peaceful life or acceptance of dying and a cowfortable death, as powering. In summary, it is possible to see, in the lived experience of patients with terminal cancer, the relationship of the five concepts of Parse's theory : valuing, revealing -concealing, connecting-separating, transforming, and powering. From Parse's theory, the results of this study show that meaning is related to valuing, rhythmicity to revealing-concealing and connect-ing-separating, and cotranscendence to transforming and powering.

• Journal of Hospice and Palliative Care
• /
• v.8 no.2
• /
• pp.131-142
• /
• 2005

Purpose: The purpose of this study was to survey the knowledge and needs of hospice for inpatients' family. Methods: This study was carried out with 277 inpatients' families at J General Hospital located in J city, Korea during the period from March to May, 2004. The data were collected through a self-reporting questionnaire constructed by the authors. The data were analyzed by descriptive statistics and $x^2-test$ with SPSSWIN 10.0. Results: 83.8% of the respondents heard about hospice mostly through mass communication. 76.9% of the respondents recognized hospice to be helpful and to provide comfort during the remainder of life and to confront the moment of death. Most of the respondents responded positively to the necessity of hospice service, and would receive hospice if necessary. 76.5% of them would consider arranging preparation for death if he/she were to be diagnosed with a terminal illness. 63.9% of the respondents wanted only to be with their family members, 31.4% wanted both the family and hospice members at the moment of death. They named the best helper among the hospice members to be the nurse. 81.6% of the respondents wanted a hospice institution to be established, 23.8% of them report that the most adequate hospice management institution would be the hospice ward in hospital. Conclusion: Consequently, most respondents wanted hospice services. So Korean society is in need of developing adequate teaching and care programs for hospice according to local needs.

• Journal of Hospice and Palliative Care
• /
• v.19 no.3
• /
• pp.249-255
• /
• 2016

Purpose: Up to 90% of pancreatic cancer patients suffer from neuropathic pain. In a palliative care setting, pain control in pancreatic cancer patient is one of the major goals. Ketamine is a N-methyl-D-aspartate (NMDA) receptor antagonist, effective in neuropathic pain. Additionally, there have been studies about the opioid sparing effect of ketamine. This study was held in the palliative care unit among pancreatic cancer patients to determine the factors related to ketamine use and the opioid sparing effect. Methods: The medical records of pancreatic cancer patients admitted to St. Mary's hospital palliative care unit between January, 2013 and December, 2014 were reviewed. Patients were divided into 2 categories according to ketamine use. Also, opioid use before and after ketamine use was compared in the ketamine group. Results: Compared to the non-ketamine use group, patients in the ketamine group required a higher dose of opioid. The total opioid dose, daily opioid dose, number of daily rescue medications, and daily average rescue dose were statistically significantly higher in the ketamine group. The opioid requirement was increased after ketamine administration. Conclusion: In this retrospective study, ketamine was frequently considered in patients with severe pain, requiring higher amount of opioid. Studies about palliative use of ketamine in a larger number of patients with diverse types of cancer pain are required in the future.

• Journal of Chest Surgery
• /
• v.34 no.9
• /
• pp.698-703
• /
• 2001

Background: Endovascular stent-graft insertion in aortic diseases is now generally accepted as an attractive alternative treatment modality. We reviewed our clinical experiences of endovascular stent-graft insertion in thoracic aorta. Material and Method: Since 1995, we performed 8 cases of endovasclar stent-graft insertion. Preoperative diagnoses were aortic aneurysms in 4, traumatic aortic ruptures in 3, and ruptured aortic pseudoaneurysm in 1. All procedures were performed in angiography room with the guidance of fluoroscopy. The stent-graft device is a custom-made 0.35mm thickness Z-shaped stainless steel wires, intertwined with each other using polypropylene suture ligation. It is covered with expanded Dacron vascular graft. Result: All procedures were performed successfully. Follow-up studies revealed 2 minimal perigraft leakages. There was no significant leakage or graft migration. 2 patients expired due to multiple organ failure and fungal sepsis. Other survivors(6) are doing well. Conclusion: Endovascular stent-graft insertion is relatively saft and effective treatment modality in the managment of various types of aortic diseases. In may be an effective alternative in aortic diseases of great surgical risk.

• Childhood Kidney Diseases
• /
• v.8 no.1
• /
• pp.10-17
• /
• 2004

Purpose : $Henoch-Sch\"{o}nlein$ purpura(HSP) nephritis has a variable range of prevalence from 25 to 50% among HSP patients and is a common cause of chronic glomerulonephritis in children. In our study, we evaluated the distribution and the association of the angioten-sinogen(AGT) M235T polymorphism with the clinical manifestations, particularly proteinuria in children with HSP with or without nephritis. Methods : The AGT M235T polymorphism was determined in children with HSP nephritis (n=33) or HSP without nephritis(n=28) who had been diagnosed at Busan Paik hospital from January 1996 to June 2001. The M235T polymorphism of the AGT gene was determined by PCR amplification of the genomic DNA. Results : The M235T polymorphism of AGT gene frequency was MM 75%, MT : 25%, TT : 0% in HSP and MM : 64%, MT : 36%, TT : 0% in HSP nephritis, there was no significant differences in the genotype and allele frequencies between the two groups. No significant differences in clinical manifestations at onset and last follow-up were seen between the two genotypes. When statistical analysis was done according to the presence of the M allele, the amount of 24-hour urinary protein excretion and the incidence of moderate to heavy proteinuria(>500 $mg/m^2/day$) at onset and at last follow-up were higher in the MT genotype than in those of in the MM genotype but these difference were not statistically significant. Conclusion : We suggest a lack of association between M235T polymorphism of the AGT gene and clinical manifestations in children with HSP nephritis. However, further follow-up studies based on sufficient number of patients and long term follow up periods are necessary to confirm the role of M235T polymorphism of AGT gene in children with HSP nephritis.

• Horticultural Science & Technology
• /
• v.30 no.4
• /
• pp.449-462
• /
• 2012

The objectives of this study were to measure the range of motion for joints and muscle activation of upper limb for flower arrangement tasks for physical rehabilitation and to test horticultural therapy programs using flower arrangement tasks for improving upper limb function of the patients with stroke. Major flower arrangement tasks were classified with eight tasks (cutting 1, thick stem; cutting 2, thin stem; fixing 1, long stem; fixing 2, short stem; rolling a leaf; bending 1, thick stem; bending 2, thin stem; and winding, using a wire) based on the occupational analysis. When eight male university students (mean age $24.1{\pm}2.5$ years) conducted the eight flower arrangement tasks, range of motion for joints and muscle activation of upper limb were measured by a 3D motion analyzer and electromyography, respectively. Based on the results of the range of motion and muscle activation of upper limb, horticultural therapy programs using flower arrangement tasks (total 33 sessions) for improving upper limb function of the patients with stroke was conducted at a rehabilitation hospital, Seoul, South Korea and then the range of motion, grip strength, and upper limb function of the patients were tested. Among the eight flower arrangement tasks, cutting 1, winding, and bending 1 induced the highest value for the range of motion in joints of shoulder, elbow, and wrist, respectively (P < 0.001). In terms of muscle activation, eight flower arrangement tasks performed in this study showed various patterns of muscle activation and several muscles were simultaneously used for each task (P < 0.001). In addition, thickness and length of the materials used in a task had a prominent effect on the range of motion for joints and muscle activation of upper limb (P < 0.001). The stroke patients had positive effects for their range of motion of upper limb (shoulder, forearm, and elbow), grip strength, and overall upper limb function through the horticultural therapy program. Thus, this study suggested that flower arrangement tasks would be a potential horticultural activity for physical rehabilitation program. It would be interesting to apply a customized horticultural therapy program using flower arrangement tasks according to the symptoms of patient for physical rehabilitation.

• Tuberculosis and Respiratory Diseases
• /
• v.44 no.1
• /
• pp.85-92
• /
• 1997

Background : The standard treatment of recurrent, symptomatic malignant pleural effusion is intrapleural instillation of a chemical agent in an attempt to achieve a sterile inflammation and pleurodesis. There are many drugs used as pleural sclerosing agents, but the efficiency and side effects are different. The present study was undertaken to compare the commonly used drugs, doxycycline and bleomycin. Methods : Thirty-four patients with malignant pleural effusion who needed repeated thoracentesis were randomized to receive treatment with intrapleural instillation of doxycycline or bleomycin Fluid volumes before and after pleurodesis, drainge time, and side effects were analyzed, and the response to treatment was evaluated by clinical examination and chest radiography during admission in the hospital. Also median survival rime were evaluated according to the responses. Results : The response rate was higher in the patients receiving doxycycline than in those receiving bleomycin (87.5% vs 50.0%, p=0.02), and fever, nausea and vomiting were more common in the patients receiving bleomycin. The median survival time was significantly longer in the patients who responded to the sclerotherapy regardless of sclerosing agents. Conclusions : Chemical pleurodesis with doxycycline or bleomycin could reduce or stop pleural effusions and prolong the median survival rimes in these patients. Doxycycline appeared to be more efficient as sclerosing agent than bleomycin in the short-term follow-up periods. But a prospective study with a larger number of patients is warranted.