• Journal of Korean Academy of Nursing
• /
• v.47 no.6
• /
• pp.842-853
• /
• 2017

Purpose: This study was conducted to identify effects of debriefing based on the clinical judgment model for nursing students on their knowledge, skill performance, clinical judgment, self-confidence and learner satisfaction during simulation based end-of-life care (ELC) education. Methods: Simulation based ELC education was developed in six steps as follows: selection of learning subjects and objects, development of learning tools, a trial run of simulation-based education, students' skill training, and evaluators' training. Forty-eight senior nursing students (25 in the experimental group and 23 in the control group) participated in the simulation-based ELC education using a high-fidelity simulator. Debriefing based on the clinical judgment was compared with the usual debriefing. Results: ANCOVA showed that there were differences in knowledge (F=4.81, p=.034), skill performance (F=68.33, p<.001), clinical judgment (F=18.33, p<.001) and self-confidence (F=4.85, p=.033), but no difference in satisfaction (t=-0.38, p=.704) between the experimental and control groups. Conclusion: This study found that debriefing based on the clinical judgement model is effective for supporting nursing students for reflecting on clinical judgment and improving their diverse competencies in complex clinical settings such as ELC.

• Journal of Korean Critical Care Nursing
• /
• v.12 no.2
• /
• pp.39-49
• /
• 2019

Purpose : The purpose of this study was to identify the extent to which intensive care unit (ICU) nurses' perceptions of life-sustaining treatment decisions and "a good death" affect attitudes toward terminal care. Method : Participants included 109 ICU nurses from three university hospitals. Data were collected using structured questionnaires, and collected data were analyzed using a t-test, ANOVA, the $Scheff{\acute{e}}$ test, Pearson correlation coefficients, and a multiple regression analysis (SPSS 24.0 program). Results : Perceptions of life-sustaining treatment decisions and a sense of closeness (a constituent for the awareness of "a good death") were positively correlated with terminal care attitudes. The factors affecting terminal care attitudes were a clinical career in ICU (${\beta}=.20$, p =.035), a sense of closeness(${\beta}=.19$, p =.041), and the perception of a life-sustaining treatment decision (${\beta}=.22$, p =.017). This finding indicates that more than 10 years of experience in ICU, a greater sense of closeness, and a higher view of life-sustaining treatment decisions results in more positive attitudes toward terminal care. The explanatory power of these variables on terminal care attitudes was 14% (F=6.84, p < .001, Adj $R^2=.140$). Conclusion : A sense of closeness and the perception of life-sustaining treatment decisions were identified as the factors affecting terminal care attitudes. Thus, various programs must be developed to raise awareness among ICU nurses of "a good death" and perceptions of life-sustaining treatment decisions.

• Journal of Home Health Care Nursing
• /
• v.29 no.3
• /
• pp.251-262
• /
• 2022

Purpose: The purpose of this study was to identify the extent to which in-hospital-based home health nurses' perceptions and anxiety about death following terminal care, affects their attitudes toward terminal care. Methods: The subjects were 128 advanced practice nurses working in hospital-based facilities for home health care, located in Seoul, Gyeonggi-do, and Incheon Metropolitan City. Data were collected from May 3, 2019, to June 3, 2019, using structured questionnaires, on terminal care and related variables based on the literature. Data were analyzed by performing the Student's t-test, one-way ANOVA, Pearson's correlation, and multivariable stepwise regression using the SPSS Version 25.0 program. Results: The scores of the attitudes toward terminal care of home health care nurses was 3.25 points out of a possible 4 points. Factors affecting nurses' attitudes toward terminal care were their concern about death(β=0.45, p<0.001), religion(β=-0.26, p=0.001) and the anxiety of others about dying(β=-0.23, p=0.003), which explained 32.0% of the observed variance concerning the factors affecting nurses' attitudes toward terminal care. Conclusion: Through this study, concern about death, anxiety about how other people process dying, and religion, were found to be associated factors. The more concerned the nurses were about death and the less their anxiety about how others process dying, the better the home health care nurses' attitude toward implementing terminal care.

• Journal of Korean Academy of Fundamentals of Nursing
• /
• v.26 no.3
• /
• pp.197-209
• /
• 2019

Purpose: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. Methods: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. Results: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=-3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=-2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=-3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. Conclusion: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life.

• Journal of Hospice and Palliative Care
• /
• v.17 no.3
• /
• pp.161-169
• /
• 2014

Purpose: This study was conducted to comprehensively investigate nursing students' experience of their first encounter with death of a patient during clinical practice. Methods: This study took place from January 27 through March 6, 2012 with eight female senior nursing students enrolled at Pusan National University located in Y city who have experienced patient death. We collected their experience of their first death encounter during their clinical rotation by asking, "What is your first experience of patient's death during the clinical practice?" Husserl's phenomenological approach was applied in this study. Results: In this study, 17 themes, 15 clusters of themes and eight categories were derived. The categories included "Desire to avoid the reality of death", "Powerlessness", "Anticipation for recovery shifted to fear of death", "Various interpretations of death", "Limitations in their nursing practice", "Resentment of lack of nurses", "Longing to better understand death", and "Motivation for inner growth". Conclusion: Through their first encounter with death of a patient, nursing students experienced various emotions and viewed their role as hospice caregiver by projecting themselves as fully trained nurses in future. Participants considered terminal care as a part of nursing care. The result of this study indicates the need to include education of death in the nursing school curriculum.

• The Journal of Korean Academic Society of Nursing Education
• /
• v.19 no.3
• /
• pp.330-340
• /
• 2013

Purpose: This study was performed to identify the level of Korean elderly's knowledge regarding concepts of end-of-life (EOL), Life-sustaining-treatment (LST), and advance directives (AD) which are critical aspects for establishing AD in Korean society. Methods: A questionnaire survey was done between October 2011 and February 2012. Knowledge of AD was evaluated with 3 aspects including EOL, LST, and AD utilizing a questionnaire that was developed by authors for the study. Data were collected from 268 community dwelling elderly from three cities and analyzed using descriptive statistics, t-tests, one-way analysis of variance, and a Scheffe post hoc test with SAS Ver. 9.1 program. Results: Overall, Korean elderly were poorly acquainted with AD related concepts. Significant differences in awareness of AD including understanding of EOL, the level of comprehension of LST, and knowledge about AD were revealed by gender, education level, economic state, and acquaintance with terms of AD or LST. Conclusion: To acknowledge autonomy and support quality of life for elderly and to meet the purpose of AD, attention should be given to target populations including elderly in terms of knowledge level related to AD, social marketing, and infra structure relevant to practice AD in our society.

• Child Health Nursing Research
• /
• v.24 no.4
• /
• pp.353-363
• /
• 2018

Purpose: The purpose of this study was to investigate pediatric nurses' perceptions regarding in end-of-life care and turnover intention. Methods: A cross-sectional descriptive study was performed among 111 hospital nurses. Pediatric nurses' perceptions of obstacles and supportive behaviors were measured using the Pediatric Nurses' Perceptions of End of Life Care Questionnaire which was translated into Korean and turnover intention was measured using the Korean Nurse Turnover Intention Scale (K-NTIS). Results: The supportive behavior with the highest perceived magnitude was 'Physicians who are compassionate, but very clear about prognosis.' The obstacle with the highest perceived magnitude was 'Instigating painful treatments when there is no hope of recovery.' Pediatric nurses' perceptions of obstacles in end-of-life care showed statistically significant differences depending on whether nurses received end-of-life care education (t=2.02, p=.046). The perception of obstacles in end-of-life care was positively correlated with turnover intention (intensity r=.28, p=.002) (frequency r=.20, p=.027). Conclusion: These results suggest that pediatric nurses' perception of obstacles and supportive behaviors in end-of-life care need to be assessed when considering turnover intention. Furthermore, psychological counseling should be offered to nurses to prevent burnout and reduce moral distress which is correlated with the turnover rate.

• Journal of Home Health Care Nursing
• /
• v.22 no.2
• /
• pp.216-227
• /
• 2015

Purpose: This study aimed at understanding terminal care provided in nursing homes. Method: An interview survey with staff in charge of terminal care was conducted in 97 nursing homes using questionnaires. The questionnaire was reviewed by 3 experts and pretested at 5 facilities. Data were analyzed using descriptive statistics, chi-square test, and Fisher's exact test. Result: Dyspnea was the most prevalent symptom predicting death. The most prevalent services were vital sign check for physical care, providing services by talking despite an unconscious state for psychosocial care, and respecting the faith of the elder for spiritual care. Employment of a registered nurse showed a significant difference in tube feeding (p=.035), analgesic administration (p=.022), informing the elder of end-of-life state (p=.020), helping an elderly person say good-byes through a visit with friends and acquaintances (p=.023), and helping express feelings related to death (p=.002). Lack of service was noticed for elderly resident, family, and staff after death of an elder. Problems related to terminal care were indifference of family members, difficulty in obtaining medical prescription, difficulty in predicting death, and so forth. Conclusion: Terminal care must be improved by making specific guidelines and it must become a part of nursing home evaluation.

• Journal of Korean Academy of Fundamentals of Nursing
• /
• v.17 no.2
• /
• pp.209-219
• /
• 2010

Introduction: The phenomenon related to sign & symptom management for end of life of the patients is of interest to researchers in nursing society today. This study was conducted to clarify and to conceptualize the factors of sign & symptom management in end of life care though nurses' perceptions on this phenomena. Methods: The qualitative study method was used to explore the experienced nurses' perceptions related to sign & symptom management in end of life care. It included a field study carried out in South Korea using in-depth interviews with 30 experienced nurses from three nursing home facilities. Results: This study identified the following categories related to end of life care with sub-categories for each category: (1) nurses' modes in identifying the signs related to patients' end of life, (2) nurses' perceived directions on patients' end of life care, (3) nurses' perceived strategies in end of life care and (4) nurses' perceived barriers in end of life care Conclusion: Through this study, characteristics of the way nurses' provide for patients' end of life care are identified, along with how nursing decisions are made to manage the sign & symptom indicating patients' end of life.

• Journal of Hospice and Palliative Care
• /
• v.7 no.1
• /
• pp.29-36
• /
• 2004

Purpose: A quantitative descriptive study aimed to identify the relationships between spiritual well-being and perception attitudes of death in nursing students. Methods: A survey was conducted and 175 data were collected. Collected data were computed and analyzed using SPSS10.0 for Win. 1) Descriptive statistics were used to identify demographic data, and 2) both t-test and ANOVA statistics were used to figure out the relationships between spiritual well-being /or perception attitudes of death and demographic data of the participants. 3) Pearson's correlation coefficient was used to identify the relationships between the two main variables. Results: 1) The mean of spiritual well-being score of the participants was $50.9943{\pm}10.7235$. Significant relationships between religion /or doing economic activity and spiritual well-being were found. 2) The mean of perception attitudes of death was $20.4914{\pm}2.6280$. There were significant relationships between gender /or age and perception attitudes of death among participants. 3) A strong positive relationship between spiritual well-being and perception attitudes of death of participants was also found(r=.261, P=.000). Conclusion: The study results shows that spiritual well-being of nursing students as caregivers of terminal patients is important when the perception of death of terminal patients is considered. Previous studies indicate that caregivers' perception attitudes impact on those of terminal patients. Therefore, it is suggested that not only perception attitudes of death and spiritual well-being in terminal patients, but also those of caregivers are importantly required to consider in educational programs in relation to spiritual care of terminal patients.