• Journal of Korean Academy of Nursing
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• v.51 no.1
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• pp.15-26
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• 2021

Purpose: This study aimed to distinguish and describe the types of perceptions of do not resuscitate (DNR) proxy decisions among families of elderly patients in a long-term care facility. Methods: This exploratory study applied Q-methodology, which focuses on individual subjectivity. Thirty-four Q-statements were selected from 130 Q-populations formed based on the results of in-depth interviews and literature reviews. The P-samples were 34 families of elderly patients in a long-term care hospital in Busan, Korea. They categorized the Q-statements using a 9-point scale. Using the PC-QUANL program, factor analysis was performed with the P-samples along an axis. Results: The families' perceptions of the DNR proxy decision were categorized into three types. Type I, rational acceptance, valued consensus among family members based on comprehensive support from medical staff. Type II, psychological burden, involved hesitance in making a DNR proxy decision because of negative emotions and psychological conflict. Type III, discreet decisions, valued the patients' right to self-determination and desire for a legitimate proxy decision. Type I included 18 participants, which was the most common type, and types II and III each included eight participants. Conclusion: Families' perceptions of DNR proxy decisions vary, requiring tailored care and intervention. We suggest developing and providing interventions that may psychologically support families.

• The Korean Journal of Health Service Management
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• v.10 no.3
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• pp.99-111
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• 2016

Objectives : This study developed an iPad-based animation for an electronic informed consent to directly help patients prepare an informed consent. The goal was to raise patients' understanding about the contents contained in a DNR informed consent in the current medical situation in which DNR informed consents are mostly written by a guardian. Methods : The development of a DNR electronic informed consent was done in 3 stages: analysis, design and development. The analysis stage was done with a survey on the real status of preparing a DNR informed consent in a medical institution. The design stage was done with the contents in the DNR electronic informed consent through a primary and secondary Delphi survey. The development stage created a DNR electronic informed consent and evaluated it through a tertiary Delphi survey. Results : After evaluating the appropriateness of the composition of the contents, the understanding of the contents, the convenience of use, the reflection of an expert opinion, and the suitability of the application, all had scores higher than 4 points. Conclusions : The results of this study show that our proposed DNR electronic informed consent can help patients better understanding the contents of a DNR informed consent.

• Journal of Hospice and Palliative Care
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• v.17 no.2
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• pp.66-74
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• 2014

Purpose: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). Methods: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. Results: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR ${\chi}^2=44.56$, P=0.001; AD ${\chi}^2=16.23$, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (${\chi}^2=7.41$, P=0.0025). Conclusion: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.

• Journal of Korean Critical Care Nursing
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• v.4 no.1
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• pp.11-24
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• 2011

Purpose: The purpose of this study was to grasp the subjectivity of the nurses toward DNR (Do not resuscitation) order. Methods: Q methodology was employed to explore the nurses' subjectivity. Q population consisted of 292 statements that were obtained through individual in-depth interviews targeting 30 employees(nurses, doctors, staff members) and literature review. Finally, 30 nurses classified 34 statements using a 9 point scale. Results: The current survey that probed into the subjectivity of the nurses relative to DNR order abstracted four categories. The first type (restrictive acceptance type) perceived the determinants of DNR as the patient's hopeless state. The second type (evidence-based type) emphasized the decision based on the guideline. The third type (medical personnel-centered type) showed the characteristic that depends passively on the professional judgement. The fourth type (rationalistic type) emphasized rational characteristic that DNR decision needs to be made by considering several situations such as economic and psychological burden of family and the quality of life. Conclusion: These types of nurse's perception need to be considered in the nurses' continuing educational program in order to confront affirmatively and positively with ethical dilemma.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.12
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• pp.4907-4921
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• 2010

The object of this descriptive survey research was to provide basic information source for building objective standards of DNR (Do Not Resuscitate) that can be clinically applied, by analyzing college students' awareness and attitude toward DNR. The participants of the study were 1,267 students from one college of Daegu, South Korea. The structured survey questionnaire was used for data collection, and the survey was conducted from 1-31 July, 2010. The error and percentage was estimated by SPSS 17.0 program, and analyzed with $x^2$-test. As a result of comparing the nursing students' and non-health care major students' awareness and attitude toward DNR, the significant differences were found in the necessity of DNR, reason for supporting DNR, reason for opposing DNR, and DNR decision-maker, among the awareness dimension; among the attitude dimension, significant differences were found in implication of family DNR and self-DNR. Comparing the nursing students' and non-health care major students' awareness toward DNR related information provision, researchers have found significant differences in the necessity of giving information on DNR, timing of the DNR information provision, result of the DNR-related information provision, and guidelines for the DNR information provision. In terms of the difference in DNR's necessity recognition by the demographic information, the significant differences existed based on the religion and the history of blood donation; in terms of the differences in attitude toward DNR decision-maker, the differences were found on the religion and the number of siblings. For the attitude toward family member's DNR, the significant differences existed for the sex, age, economic status, religion, the number of siblings, the history of familial illness and death, and experience of blood donation; the attitude toward the DNR for the self was significantly differed by the sex, economic status, the number of siblings, and the history of familial illness and death. To establish the standards for DNR based on the study, we suggest more well-designed future studies.

• Journal of Digital Convergence
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• v.13 no.11
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• pp.187-196
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• 2015

The purpose of this study was to examine the understanding of contents and the convenience of use of the DNR animation mobile electronic informed consent. The subjects in this study were inpatients of long-term care hospital. As for data analysis, a statistical package SPSS 21.0K was employed. The findings of the study were as follows: First, DNR choice was 33.0%, CPR choice was 54.0% in case of the outbreak of cardiac arrest. Their principal diagnosis made statistically significant differences to their choice of DNR and CPR. Second, they got 2.50 in the understanding of the content of the DNR electronic informed consent, and got 2.37 in the convenience of use. Given the findings of the study, the DNR animation electronic informed consent is expected to help patients to have a better understanding of contents, to make their decision to choose DNR or CPR, and to sign the DNR informed consent forms themselves.

• The Korean Journal of Rehabilitation Nursing
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• v.14 no.2
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• pp.118-128
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• 2011

Purpose: The purpose of this study was to explore the experiences of bereavement for main family members who had made and followed DNR decision for their family members. Method: This qualitative study was based on a grounded theory, and used in-depth interview techniques with the bereaved 10 main family members who had been treated and died under DNR order. Results: The causal condition of the family member was 'Releasing', and the main consequent phenomenon were 'Blaming self and ruminating'. The contextual condition was 'The memory of the deceased'. The action/reaction strategy was 'Purifying'. The intervening condition was 'Supporting system', and the consequence was 'Acceptance'. The experience after bereavement of the family member on DNR decision were rational processes that purified themselves and healed the guilt feeling about the decision from reflective assessment and response about DNR decision. Based on this results, the substantive theory 'Reflective self healing' was derived. Conclusion: The main family members in following DNR decision are more likely to have unhealthy emotional condition than others in normal bereavement process. But they overcame the grief of bereavement through reflective self healing process.

• Journal of Hospice and Palliative Care
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• v.20 no.2
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• pp.93-99
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• 2017

Purpose: This study investigated changes in life-sustaining treatments in terminally ill cancer patients after consenting to a do-not-resuscitate (DNR) order. Methods: Electronic medical records were reviewed to select terminally ill cancer patients who were treated at the oncology unit of the Asan Medical Center, a tertiary hospital in South Korea and died between January 1, 2013 and December 31, 2013. Results: The median (range) age of the 200 patients was 59 (22~89) years, and 62% (124 persons) were male. Among all patients, 83.5% were aware of their medical condition, and 47.0% of the patients had their DNR order signed by their spouses. The median of the patients' hospital stay was 15 days, and time from admission to DNR decision was 10 days. After signing a DNR order, 35.7~100% of the life-sustaining treatments that had been provided at the time of the DNR decision making were administered. The most commonly discontinued interventions were transfusion (13.5%), blood test (11.5%) and parenteral nutrition (8.5%). Conclusion: It is necessary to define the scope of life-sustaining treatments for DNR patients. Treatment guidelines should be established as well to secure terminal patients' death with dignity after their consent to a DNR order, thereby avoiding meaningless life-sustaining treatments and allowing administration of active terminal care interventions.

• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.216-222
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• 2013

Purpose: The purpose of this study was to examine nurses' emotional responses and ethical attitudes towards elderly patients' Do-Not-Resuscitate (DNR) decision. Methods: Data were collected using a questionnaire which was filled out by 153 nurses who worked in nursing homes and general hospitals. Data were analyzed using real numbers, percentages, means, standard deviations and Pearson's correlation coefficients with SPSS 19.0 program. Results: The average score for ethical attitudes towards the DNR decision was 2.68 out of 4. Under the ethical attitudes category, the highest score was found with a statement that said 'Although they will not perform cardiopulmonary resuscitate (CPR), it is right to do their best with other treatments for DNR Patients'. Items regarding emotional responses to the DNR decision, the average score was 2.36 out of 4. Among them, the highest score was achieved on 'I understand and sympathize'. No significant correlation was found between ethical attitudes and emotional responses in relation to patients' DNR decision (r=-0.12, P=0.13). Conclusion: Regarding elderly patients' DNR decision, nurses showed somewhat highly ethical attitudes and slightly positive emotional response. A follow-up study is needed to investigate variables that affect our results.

• Journal of Hospice and Palliative Care
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• v.20 no.2
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• pp.122-130
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• 2017

Purpose: The purpose of this study is to describe and understand the meaning and the structure of subjective experiences of intensive care nurses with death of patients with do-not-resuscitate (DNR) orders. Methods: Data were collected from eight intensive care nurses at general hospitals using individual in-depth interviews and analyzed by phenomenological research method. Results: The nurses' experiences were grouped into four theme clusters: 1) ambiguity of death without correct answer, 2) a dilemma experienced at the border between death and work, 3) the weight of death that is difficult to carry and 4) death-triggered reflection of life. Conclusion: It is necessary to develop accurate judgment criteria for DNR, detailed regulations on the DNR decision process, guidelines and education on DNR patient care for nurses. It is also needed to develop an intervention program for DNR patients' families.