• Journal of Hospice and Palliative Care
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• v.22 no.4
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• pp.174-184
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• 2019

Purpose: The aim of this study was to analyze the current status of end-of-life (EoL) care education of the undergraduate nursing curriculum and senior students' EoL care experience and competency. Methods: A survey was conducted with 41 nursing schools and 622 senior nursing students on June 2018. The questionnaire consisted of 38 items on teaching regarding EoL care and 17 items on EoL care competencies based on the suggestions made by the American Nurses Association. Results: Only 20% among 41 nursing schools opened an EoL care course as an elective, and the course was taken by 5.1% students. Of 622 students, 70.7% witnessed death of patients during their clinical training, but 74.8% received no or little education on EoL care from their clinical training instructors. Two of 38 education contents on EoL care were taught in class for over 80% of the students. All students scored below 3 points (2.31±0.66) for all 17 competencies, which means that they cannot perform EoL care. Conclusion: This study showed that there was a serious deficiency in undergraduate nursing education on EoL care. Accordingly, most nursing students who would graduate soon considered themselves incapable of performing EoL care. Nurses experience death and dying as a part of their practice and should be prepared to provide adequate EoL care. Therefore, it is urgent to improve EoL care training in the undergraduate nursing education.

• Journal of Hospice and Palliative Care
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• v.16 no.2
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• pp.108-117
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• 2013

Purpose: The objectives of this study were to 1) explore nurses' attitudes toward death, coping with death, understanding and performance regarding end-of-life (EOL) care, 2) describe correlations among the above factors, and 3) determine the factors affecting nurses' EOL care performance. Methods: Study participants were 187 nurses stationed at departments that post higher mortality than others such as the oncology department, intensive care unit (ICU) and emergency department (ED). Data were collected from three urban university-affiliated hospitals. Multi-dimensional measure was performed for study instruments such as "attitude toward death", "coping with death" and "understanding and performance regarding EOL care". Data were analyzed by using descriptive statistics, correlation, and multiple regressions. Results: First, nurses showed significantly different attitudes toward death by age, religion, work unit and EOL care education. Younger nurses tend to score low on the understanding of EOL care, and ED nurses' score was lower than their peers at the oncology department and ICU. Second, EOL care performance was positively correlated with attitude toward death (P<0.001), coping with death (P=0.003) and understanding of EOL care (P<0.001). Third, nurses' EOL care performance was affected by work unit (P<0.001) and understanding of EOL care (P<0.001). Conclusion: Because nurses' performance was influenced by their work unit and understanding of EOL care, they should be provided with appropriate training to improve their understanding of death and EOL care according to work unit.

• Journal of Hospice and Palliative Care
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• v.11 no.3
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• pp.140-146
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• 2008

Purpose: Sooner of later, end-of-life care decision-making will unfold and be settled during the professional lives of medical students. However, there is prevalent ambiguity and uncertainty between the palliative treatment and euthanasia. We conducted this survey to investigate attitudes of medical students towards end-of-life making decisions, and to find out which factors primarily influenced the attitudes. Methods: A study was conducted among medical students at one university, the Republic of Korea. A written questionnaire was sent to all the 1st, 2nd, and 3rd-year medical students. It presented 5 statements on end-of-life decision-making. Students were asked whether they agreed or disagreed with each statement. Results: The response rate was 74.4%, and 267 questionnaires were analyzed. Percentages of agreement with each statements on Voluntary active euthanasia (VAE), Physician assisted suicide (PAS), Withholding life-sustaining management, Withdrawing life-sustaining management, and Terminal sedation (TS) was 37.1%, 21.7%, 58.4%, 60.3%, and 41.6%, respectively. The grade of students, religious activity, and educational experience were determinant factors. Agreement on each statements was higher in the low religious activity group than in the high religious activity group. Agreement on TS was higher among 3rd year students during their clerkship than among 1st and 2nd year students. Age of students and the experience of dying-people care had no significant influence. Conclusion: In end-of-life decision-making, religious and educational factors influenced medical students' attitudes. Especially, the experience of education during clerkship had significant influence on the attitude. Proper teaching on end-of-life decisions should further be considered during medical students' clerkship.

• Journal of Hospice and Palliative Care
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• v.13 no.4
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• pp.243-251
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• 2010

Purpose: This study was conducted to investigate how nurses who take care of terminal patients perceive fluid therapy and how this therapy is currently being used in hospitals. Methods: This survey included 200 nurses, 87 of whom were working in the oncology units of 3 university hospitals in Seoul, Korea, and 113 were working in 18 hospice centers. The data for this study were collected by means of structured questionnaires and analyzed by using the Statistical Analysis System software. The differences in perception towards fluid therapy between nurses working in oncology units and those working in hospice centers were examined using the $x^2$ test and analysis of covariance. Results: Fluid therapy was perceived more negatively by the nurses from hospice centers than by those from oncology units. Continuous subcutaneous infusion was used in hospice centers, but not in oncology units. In addition, the average amount of fluid infused daily differed significantly between the oncology units and hospice centers. Conclusion: Our results show that there were differences in the perception towards fluid therapy between nurses in different clinical settings. Nurses caring for terminal and palliative care patients should not simply provide or withhold fluid therapy, but rather develop a wider range of views on fluid therapy, focusing on effective alternative interventions.

• Journal of Hospice and Palliative Care
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• v.15 no.1
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• pp.30-35
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• 2012

Purposes: Most medical schools in Korea do not provide adequate education in end-of-life care. This study was designed to illustrate the need to improve end-of-life care education and to assess the effect of the education on fourth-year medical students' awareness and attitude towards hospice and palliative care for terminally ill patients. Methods: One hundred sixty six fourth-year medical students were surveyed with questionnaires on end-of-life care before and after they received the education. Results: Before receiving the education, students most frequently answered "at the end of life" (33.6%) was appropriate time to write an advance medical directive. After the education, the most frequent answer was "in healthy status" (58.7%). More students agreed to withholding or withdrawing futile life-sustaining treatment increased after the education (48.1% vs. 92.5% (P<0.001) for cardiopulmonary resuscitation, 38.3% vs. 92.5% (P<0.001) for intubation and mechanical ventilation, 39.1% vs. 85.8% (P<0.001) for inotropics, 60.9% vs. 94.8% (P<0.001) for dialysis and 27.8% vs. 56.0% (P<0.001) for total parenteral nutrition). Significantly more students opposed euthanasia after the education (46.6% vs. 82.1%, P<0.001). All students agreed to the need for education in end-of-life care. Conclusion: After reflecting on the meaning of death through the end-of-life care education, most students recognized the need for the education. The education brought remarkable changes in students' awareness and attitude towards patients at the end of life. We suggest end-of-life care education should be included in the regular curriculum of all medical schools in Korea.

• Journal of Hospice and Palliative Care
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• v.12 no.1
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• pp.5-13
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• 2009

Purpose: This exploratory study was undertaken to analyze the information needs of family members of terminal cancer patients, collected through the telephone counselling service by National Cancer Information Center. Methods: The study included 113 family members of terminal cancer patients who had enrolled at the National Cancer Information Center for the period from June, 2007 through March, 2008 and had agreed to the survey. Results: The subjects (n=113) consisted of grown-up children (n=82) and spouses (n=8) of patients'. Those in their 40's (n=40) and 30's (n=36) accounted for the majority of the sample. The questions raised most were about the information on treatment methods (n=117), management of terminal cancer patients (n=46), terminal cancer patients' life (n=27), deathbed and prediction of remaining life (n=18), hospitalization (n=16), and financial support (n=15). Most of the subjects were satisfied with the telephone counseling services, and 69% of the subjects had come to know about the telephone counseling service via Internet, and 10.6% of them stated that the PR for the service was poor. Conclusion: It is deemed essential for the government to use the mass media for PR of the hospice services, since family members of terminal cancer patients' are less aware of the hospice conducive to enhancement of patients' remaining quality of life, being involued too deeply in their treatment.

• Journal of Hospice and Palliative Care
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• v.22 no.4
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• pp.156-165
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• 2019

Purpose: This study was conducted to identify subjective attitudes towards terminal patients in nursing students who had clinical practice. The types of subjective attitude were classified by applying Q methodology. According to those types, basic reference data for the development of educational programs were provided. Methods: Thirty-four final Q samples were selected, and Q classification with a nine-point scale was performed with P samples of 43 nursing students. A key factor analysis was conducted with the collected data using the PC QUANAL program. Results: Nursing students' attitudes towards terminal patients were grouped into three types. The total variable was 49.96%. Students with Type 1 ("wish for life-sustaining medical treatment") thought that terminal patients accurately understood their medical condition and wanted to prolong their lives. Others with Type 2 ("need for service and support") believed that a multidisciplinary nursing system needs to be established to help terminal patients prepare for death. Students with Type 3 ("awareness and acceptance of death") thought that terminal patients wanted to die with dignity at a hospice unit. Conclusion: This study analyzed various types of attitude towards terminal patients, as perceived by nursing students with clinical training experience. Development of educational programs for each attitude type analyzed in this study could contribute to systematic training programs for nursing students caring for terminal patients.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.335-373
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• 2014

According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

• Journal of Hospice and Palliative Care
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• v.15 no.3
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• pp.147-154
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• 2012

Purpose: The purpose of this study is to understand family members' experience of deciding to withdraw life-sustaining treatments for terminally-ill patients in an unconscious state. Methods: Data were collected by performing an in-depth interview with eight terminally-ill patients' family members who decided to withdraw life-sustaining treatments. Colaizzi's phenomenological method was used for data analysis. Results: Questions were classified into 12 groups and finally into five categories. The five categories were about family members' frustration with patient's condition, emotional preparation for the patient's death upon medical professionals' recommendation, patient's wishes, exhaustion due to caring and past experiences related to life-sustaining treatment. Conclusion: Using the five categories, hospice and palliative professionals could better understand family members' decision making experience of withdrawing life-sustaining treatments for terminally-ill patients. Based on that, the family members could be provided with appropriate counseling and care, which in turn could improve hospice and palliative care intervention.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.867-874
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• 1996

This study was designed to assess the left ventricular peak systolic pressure/end-systolic volume (PSP/ESV) ratio in predicting symptomatic improvement with valve replacement in patients with aortic regurgitation and enlarged left von'lrlcular volume. We studied 21 patients (15 men and 6 women aged 15 to 60 years) with moderate or severe aortic regur- gitation, no other cardiovascular abnormalities and left ventricular end-systolic volume over 60 m11m2. In this group we assessed the preoperative variables which routinely were measured at cardiac catheterlzation to predict symptomatic improvement with valve replacement. Six months after operation, symptoms were alleviated in 13 patients(62%), and unchanged in 8()8%). By multivariate analysis, the PSP/ESV rati was a strong predictor for functional class 6 months after surgery(p=0.005) and also for change- in functional class prior to an operation to 6 months postoperatively(p=0.0)2). By 6 months after receiving valve replacement, all patients with a ratio over 1. 71 mmHglml/m'were in functional class I or II , in contrast, of those with a ratio < 1.71 mmHg/ml/m2, 40% were in functional class III. The PSP/ESV ratio may help to predict which patients with aortic regurgitation and enlarged left ven- tricular end-systolic volume will have symptomatic improvement with valve replacement.