• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.4
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• pp.2691-2703
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• 2015

This research aims to provide basic materials for assisting DNR patient cares by understanding ICU nurses' awareness and ethical attitude regarding DNR. A total of 154 results were analyzed which were collected from Aug. 1st to Sep. 5th in 2014 by surveying nurses working in ICU (from 1 advanced general hospital in G metropolitan city and other general hospitals of more than 700 beds in Cheolla provinces). (1) For the decision attitudes of DNR, there were both consent and objection. Consent for the patient's opinion of rejecting further treatment and life extension despite of bad prognosis. And objection for no conducting DNR in the case of the patient's wish, treatment requested by the guardian, and CPR for the patient who has no chance. (2) Objection for artificial respirator and other treatment requested by the patient's family and the entrance of guardians into ICU. Consent for the passive use of artificial respirator by the doctor and the decrease of basic care to stabilize patients physically and mentally. No specific opinion for treatment not following aseptic techniques. Objection for frequent reports to primary care physician requested by the family. (3) Acknowledging less interest by the doctor, while supporting the health care team in the case of the guardian's complaint, objection for the DNR decision mede by the primary care physician. Objection for the DNR decision by the guideline. Objection or neutrality for straightforward explanation to the patient of bad prognosis. Objection for straightforward explanation of the patient's status (even near to death) to the patient him/herself or the guardian. In conclusion, the subject of DNR is the patient and the patient's opinion should be fully reflected. The conflict arising from the scope of medical practice and decision processes should be minimized. The standard and guideline for DNR decision is required for the ethical decision making for the patient along with agreements based on full explanations.

• Journal of Korean Clinical Health Science
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• v.3 no.2
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• pp.361-371
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• 2015

Purpose. The purposed of this study was done to DNR attitude and terminal care performance among hospital nurses. Methods. The participants were 207 nurses working in hospital nurses in D and G cities. Data on DNR attitude and terminal care performance were collected via questionnaire between April 2015 and July 2015. Data analysis was done with SPSS 12.0 program and included one-way ANOVA, independent t-test, and Pearson correlation. Result. DNR attitude of participants in this study were shown to have high levels (DNR attitude: M=32.64/60, SD=6.14). Terminal care performance of participants in this study were shown to have poor levels (physical M=20.72/32, SD=3.77, psychological M=20.26/32, SD=3.85, spiritual M=9.62/24, SD=3.65). The attitude of the hospital nurse was significantly different according to the marital status. The terminal care performance was significantly different according to experience of terminal care. The DNR attitude by nurses was positively correlation to physioloical terminal care performance(r=.137, p<.049) but the relationship between the psychological terminal care performance( r=.016, p=.815) and spiritual terminal care performance showed no correlation(r=-.099, p=.157). Conclusion. The results of this study indicate that it is necessary to increase DNR attitude and to encourage terminal care performance among hospital nurses.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.18 no.3
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• pp.411-420
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• 2011

Purpose: The aim of this study was to exam differences in awareness and ethical attitudes associated with Do-Not- Resuscitate (DNR) among emergency department's team. Method: The participants in this study were 402 emergency department's team working in the 41 hospitals. The data was collected by using "awareness measuring tool" by Kang (2003) and "ethical attitudes measuring tool" by Ko (2004) from May 1 to September 15, 2009. Collected data were analyzed by descriptive statistics, t-test, Pearson correlation coefficient using SPSS WIN 14.0 program. Results: 74.4% of subjects was responded that they had never been educated about DNR, but 73.9% of subjects was responded that they had experienced DNR in the emergency room. The majority of subjects responded that the patients and their families should make a decision about the DNR. There was a difference in an appropriate time for explanation of DNR among emergency department's team. There was a difference in ethical attitudes associated with Do-Not- Resuscitate among emergency department's team. Conclusion: For a professional and systematic approach to the problem, DNR guideline sufficient to elicit a social consensus is needed.

• Korean Journal of Adult Nursing
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• v.25 no.3
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• pp.322-331
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• 2013

Purpose: This study was conducted to understand the meaning of the DNR experiences of nurses. Methods: The data were collected through in-depth interviews, observation, and field records with five nurses from November 2009 to February 2011. The data were analyzed using narrative inquiry methodology. Results: Three fundamental themes were derived from data analysis as following: 'faithfulness to care for comfort,' 'helping for peaceful farewells between the patient and the family,' 'reflecting one's lives with a collision of feeling toward the death.' Conclusion: The results indicate that nurses take a role of an advocate in caring for DNR patients and being concerned about their families' conflict and anguish. In addition, this study indicates the importance of education on living will, advanced directives and preparation for the death tailored to the public including healthcare professionals.

• Journal of Korean Society of Water and Wastewater
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• v.9 no.4
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• pp.115-123
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• 1995

The purpose of this study is to investigate the characteristics and performance of nitrogen and phosphorus removal system, Daewoo Nutrients Removal(DNR) system, and to find out the operating parameter for the system. During the study, $10m^3$ pilot plant was operated for the demonstration experiment and the primary effluent was taken from K domestic sewage treatment plant. The TN in the influent had been removed to approximately 70% through the nitrfication in the oxic tank and the denitrfication in the anoxic tank and the $PO_4-P$ and TP in the influent had been removed to 85% and 83% through anaerobic reaction and oxic reaction. The BOD and SS removal rate were 85 to 95% through the system. As the results, the values of effluent BOD, SS and slouble phosphorus were lower than A/O and $A^2/O$ processes. The SPRR (specific phosphorus release rate) at the anaerobic state of DNR system was ranged from 2.2 to 2.6mg SP/g VSS/h. The nutrient removal efficieny of the DNR system in view of the characteristics of the domestic sewage was higher than the pre-established A/O and $A^2/O$ processes. Finally, we believe that the DNR system was superior to the processes deveolped recently.

• 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 Korean Society of Water and Wastewater
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• v.20 no.2
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• pp.273-280
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• 2006

The sludge settleability is a key factor for operating activated sludge process as well as BNR (biological nutrient removal) process, because the poor sludge settling causes an increase of suspended solid in the effluent. In order to improving the sludge settleability, a settling agent such as iron dust can be applied. In this study, the effect of sludge settleability on the performance of DNR (Daewoo nutrient removal) process was investigated with GPS-X, which is the popular wastewater treatment process model program, and the result of modeling was verified with operating lab-scale DNR process. As a result, if the sludge blanket keeps stable in the secondary settling tank, the effluent quality is similar in spite of different SVI values. And in case of the good sludge settleability, short HRT or long SRT increased the biomass concentration in the bioreactor, and improved the pollutant removal efficiency. In spite of daily influent changing, the good sludge settleability also guaranteed the stable effluent quality. And the results of the lab-scale DNR process experiment could support the simulated results.

• 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 the Korea Academia-Industrial cooperation Society
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• v.17 no.10
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• pp.647-654
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• 2016

The aim of this study was to investigate the effects of death education on the attitude toward DNR, fatigue, and quality of sleep for generic care worker. This study followed a nonequivalent control group and a non-synchronized design. This study was performed in a visiting generic care service institution in J city, Chung-Cheong province, Korea between February 15 to May 30, 2016. The study included 43 participants who agreed to participate in this study. They were randomly divided into two groups: 21 participants in the experimental group and 22 in the control group. Participants in the experimental group received death education 2 hours per day, once a week, for a duration of greater than 8 weeks. The effect of treatment was measured using a structured questionnaire on the attitude toward DNR, fatigue, and quality of sleep before and after 8 weeks of intervention. Data were analyzed using t-, chi-square, Fisher Exact- and paired t-tests. The experimental group showed a significantly increased attitude toward DNR (p=0.001) and quality of sleep (P<0.001), whereas significantly decreased attitude toward fatigue (p=0.030) than the control group after 8 weeks of intervention. The death education program was shown to be an effective nursing intervention for generic care workers. Therefore, we can consider the possibility of incorporating death education in the nursing program.

• Korean Journal of Adult Nursing
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• v.28 no.3
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• pp.334-342
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• 2016

Purpose: This study was conducted to identify factors that influence on self-determination for withdrawal of life-sustaining treatment in the community dwelling elderly. Methods: This study used a descriptive correlational design. A convenience sample of 201 elderly were recruited from a welfare center located in Seoul, Korea. Data collection was done from September 1 to September 18, 2015. Four survey questionnaires were used: Multidimensional Scale of Perceived Social Support (MSPSS), Life Satisfaction Index-Z (LSI-Z), Attitude on Do Not Resuscitate (DNR), and Self-determination for Withdrawing Life-sustaining Treatment. Data analysis was done by t-test, ANOVA, Pearson's correlation, and hierrarchical multiple regression. Results: Hierarchial multiple regression showed that the factors predicting the level of self-determination for withdrawing life-sustaining treatment were educational level, DNR experience in family, life satisfaction, and DNR attitude. These factors explained 44% of the self-determination for withdrawing life-sustaining treatment in community dwelling elderly. Conclusion: The results of this study suggest developing educational programs aiming at changing elderly's DNR attitude positive ways so that they can enhance self-determination for withdrawing life-sustaining treatment. Further study is needed with more elderly population in extended areas.