• 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.

• The Korean Journal of Emergency Medical Services
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• v.18 no.2
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• pp.95-108
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• 2014

Purpose: This descriptive study examined awareness of and ethical attitudes associated with Do Not Resuscitate (DNR) orders in 119 emergency medical technicians (EMTs). Method: In total, 255 paramedics and basic EMTs completed questionnaires between March and May, 2013. Data were analyzed using the SPSS WIN 18.0 program. Results: A chi-square analysis revealed significantly different responses given by paramedics and basic EMTs: Paramedics gave "the reason in which DNR is not necessary", as being "due to unclear DNR decision time" whereas basic EMTs answered that this was "due to a legal problem" ($x^2$ = 12.680, p < .05). Paramedics disagreed with the statement, "It is natural for medical teams to have less interest in patients with DNT orders", whereas basic EMTs agreed with the statement ($x^2$ = 6.666, p < .05). Conclusion: A unified manual on attitude toward DNR orders, taking account of social and culture factors, needs to be developed. This research provides a base line for future research.

• Journal of Korean Clinical Nursing Research
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• v.16 no.3
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• pp.73-84
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• 2010

Purpose: The purpose of this study was to investigate the ethical awareness and attitude of patients' families towards Do-Not-Resuscitate(DNR), and thus provide basic information required to develop Korean appropriate DNR instructions and practice informed consent for DNR. Methods: During April 2010, 219 patient family members visiting the hospital were surveyed using a questionnaire. Results: Most of the participants preferred DNR to meaningless treatment for incurable patients. They recognized the necessity of explaining DNR to the patient with a terminal disease. They also requested DNR orders for themselves if they were in the same medical condition. In making a DNR decision, the patient's family agreed and preferred that it reflect the opinion of the patient and the doctor in charge. They also agreed that treatment should be given with the best efforts even if a DNR decision had been made for the patient. Conclusion: To make a decision on DNR for a patient who is terminally ill or for whom survival is not possible, a practice of informed consent and guidelines for executing the DNR reflecting the patient's opinion are required.

• Journal of Hospice and Palliative Care
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• v.18 no.3
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• pp.208-218
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• 2015

Purpose: Although a Do-Not-Resuscitate (DNR) order is widely in use, it is one of the challenging issues in end-of-life care. This study was conducted to investigate attitudes toward DNR according to education and clinical experience. Methods: Data were collected using a structured questionnaire comprising 30 items in a tertiary hospital in Seoul, Korea. Results: Participants were 238 nurses and 72 physicians. Most participants (99%) agreed to the necessity of DNR for reasons such as dignified death (52%), irreversible medical condition (23%) and patients' autonomy in decision making (19%). Among all, 33% participants had received education about DNR and 87% had DNR experience. According to participants' clinical DNR experience, their attitudes toward DNR significantly differed in terms of the necessity of DNR, timing of the DNR consent and post-DNR treatments including antibiotics. However, when participants were grouped by the level of DNR education, no significant difference was observed except in the timing of the DNR consent. Conclusion: This study suggests that the attitudes toward DNR were more affected by clinical experience of DNR rather than education. Therefore, DNR education programs should involve clinical settings.

• Journal of Hospice and Palliative Care
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• v.18 no.3
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• pp.179-187
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• 2015

For patients who are near the end of life, an inevitable step is discussion of a do-not-resuscitate (DNR) order, which involves patients, their family members and physicians. To discuss DNR orders, patients and family members should know the meaning of the order and cardiopulmonary resuscitation (CPR) which includes chest compression, defibrillation, medication to restart the heart, artificial ventilation, and tube insertion in the respiratory tract. And the following issues should be considered as well: patients' and their families' autonomy, futility of treatment, and the right for death with dignity. Terminal cancer patients should be informed of what futility of treatment is, such as a low survival rate of CPR, unacceptable quality of life after CPR, and an irremediable disease status. In Korea, two different law suits related to life supporting treatments had been filed, which in turn raised public interest in death with dignity. Since the 1980s, knowledge of and attitude toward DNR among physicians and the public have been improved. However, most patients are still alienated from the decision making process, and the decision is often made less than a week before death. Thus, the DNR discussion process should be improved. Early palliative care should be adopted more widely.

• 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.

• The Korean Journal of Health Service Management
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• v.7 no.2
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• pp.37-52
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• 2013

The purpose of this study was to compare the differences of attitude to death and perception on HPC between nursing and medical students. The data was collected by questionnaires and the period of data collection was from September 17 to October 12, 2012. The results were as followings. Statistically significant differences were found course of knowing HPC(${\chi}^2$=24.29, p<.001), reason of unactive introduction(${\chi}^2$=15.92, p=.003), having to CPR in irresponsive terminal situation to you(${\chi}^2$=4.62, p=.032) and to your family(${\chi}^2$=5.64, p=.018), decision-making about DNR(${\chi}^2$=12.28, p=.002), awareness to medical authority legal representative(${\chi}^2$=14.75, p<.001), awareness (${\chi}^2$=11.01, p=.001) and subject(${\chi}^2$=24.73, p<.001) of AD, addiction(p<.001), tolerance(p<.001), taking a point(${\chi}^2$=23.28, p<.001) of narcotic analgesics and control of pain(p=.532). The findings of the study provides the basis for expanding practice and education to hospice-palliative care for nursing and medical students.

• 한국노년학
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• v.30 no.4
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• pp.1197-1211
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• 2010

This research was concucted to present a model of advance directives(AD) when a patient, who is in consciousness, shows a preference for an end of life care as an act of preparing for an uncertain situation that may arise in the forseeable future. The subjects of the research are 383 doctors/nurese and adults, who live in six cities and provinces, to investigate the status of AD, attitude regarding a meaningless life-prolonging treatment, and moreover, an understanding of and a preference for AD. The research was done by the well-structured questionnaire. Also, SPSS 14.0 is used to analyse the collected data, focused on frequency analysis, avearage and standard deviation, X2 test. As the results of the study, the most of the surveyed doctors/nurese knew DNR orders and AD and a few of them used DNR orders and AD practically. Also, the result shows that there is a negative conception of meaningless life-prolonging treatment among the responents, in addition, most of them agreed upon the idea of introducing AD to Korea, filling it out and making it legally effective. As a method of making AD out, the respondents wanted to use a form that mixed living will with an Power of Attorney in a document. Also, considering the appropriate time, respondents prefered when they are diagnosed with terminal illness. At the moment, the introductory model for AD, which is suitable for the Korean culture and current situation is presented based on the result of this research. In the future, other researches should deal with specific measures that can lead to a social consensus to adopt AD in Korea.

• Journal of Korean Academy of Nursing
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• v.37 no.7
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• pp.1166-1176
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• 2007

Purpose: The purpose of this study was to categorize adult's subjectivity of their attitudes towards life sustaining treatment, and thereby understand the differences among these life sustaining treatment types using Q methodology. Methods: Q-methodology, which provides a method of analyzing the subjectivity of each item, was used. Thirty selected Q-statements received from 52 adults were classified into a shape of normal distribution using a 7 point scale. The collected data was analyzed using a QUANL pc program. Result: Four types of attitudes toward life sustaining treatment were identified. Type I is called one's autonomy type. Type II is called potentiality of resuscitation type. Type III is called DNR (Do not resuscitation) type. Type IV is calledone's effort type. Conclusion: The results of the study indicate that different approaches of life support care programs are recommended based on the four types of life sustaining treatment attitudes among Korean adults.