• 제목/요약/키워드: Hospice Patients

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Ethical Issue of Physician-Assisted Suicide and Euthanasia

  • Myung Ah Lee
    • Journal of Hospice and Palliative Care
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    • 제26권2호
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    • pp.95-100
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    • 2023
  • With the implementation of Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life, interests of the general public on self-determination right and dignified death of patients have increased markedly in Korea. However, "self-determination" on medical care is misunderstood as decision not to sustain life, and "dignified death" as terminating life before suffering from disease in terminal stage. This belief leads that physician-assisted suicide should be accommodated is being proliferated widely in the society even without accepting euthanasia. Artificially terminating the life of a human is an unethical act even though there is any rational or motivation by the person requesting euthanasia, and there is agreement thereof has been reached while there are overseas countries that allow euthanasia. Given the fact that the essence of medical care is to enable the human to live their lives in greater comfort by enhancing their health throughout their lives, physician-assisted suicide should be deemed as one of the means of euthanasia, not as a means of dignified death. Accordingly, institutional organization and improvement of the quality of hospice palliative care to assist the patients suffering from terminal stage or intractable diseases in putting their lives in order and to more comfortably accept the end of life physically, mentally, socially, psychologically and spiritually need to be implemented first to ensure their dignified death.

호스피스 전개에 있어서 과제와 방향에 대한 모색 -호스피스 전개를 위한 교육적 측면에서- (Review on the Approaches and Issues of the Hospice Care Program)

  • 조유향
    • 보건교육건강증진학회지
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    • 제11권2호
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    • pp.146-159
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    • 1994
  • The conecpt of hospice care for the terminally ill is a development of relatively modern times, although it has its origins in antiquity. The hospice will be able to handle progressively more and more patient, to the limit of its resources. The purposes of this study were to review of demand and issues of the hospice care programes and to recommand the hospice care approaches in south Korea that using the book-review method. At this point, although at present there is a general unawareness of hospice throughout Korean society, the public will become gradually aware of hospice. This will thus aid the development of hospices. Awareness will come about because of the educational efforts of medical schools, nursing schools, allied health training programs, practicing hospice care giver, universities, and others interested in hospice education. At present, there are many issues of the hospice care program that are hospice resources problems of manpower, facilities, finances, and cost of hospice services, quality of care, and ethics. Additional studies are needed to determine the most efficacious organizational hospice models for varying conditions. They will insist upon reasonable regulatory agency regulations that will promote the hospice idea and. permit adequate remuneration for services provided. More research is needed on health professionals', patients', and others' attitudes towards death.

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호스피스 자원봉사자들의 말기 AIDS 환자들에게 자원봉사를 제공할 의향에 영향을 미치는 요인 (Factors Associated with Willingness to Volunteer for End-Stage AIDS Patients among Hospice Volunteers)

  • 윤석준;최영심;정진규;김종성;류혜원
    • Journal of Hospice and Palliative Care
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    • 제20권4호
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    • pp.226-234
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    • 2017
  • 목적: '연명의료결정법'의 시행으로 호스피스 완화의료의 대상이 암뿐 아니라 후천성면역결핍증(acquired immunodeficiency syndrome, AIDS)을 포함한 비암성 질환에까지 확대된다. 하지만, AIDS에 대해서는 부정적인 인식과 낙인, 편견이 많아 호스피스 완화의료 확대에 대한 우려가 많다. 이에 본 연구에서는 말기 AIDS 환자들에 대한 자원봉사 제공의향 정도에 영향을 주는 요인들을 알아보고자 하였다. 방법: 우리나라의 19개 기관의 326명의 호스피스 자원봉사자들을 대상으로 자가 기입식 설문지를 이용해 조사하였다. 말기 AIDS 환자들에 대한 자원봉사 제공의향 정도는 11단계 숫자등급을 통해 파악하였다. 인구사회학적 변수들, 자원봉사와 관련된 변수들, 자원봉사에 대한 만족도, AIDS에 대한 지식 수준, AIDS에 대한 태도('AIDS 환자에 대한 두려움', 'AIDS 환자에 대한 부정적인 태도', '개인적인 낙인', '낙인적 태도')를 조사하였다. 다중회귀분석을 이용하여 말기 AIDS 환자들에 대한 자원봉사 제공의향 정도에 영향을 주는 요인들을 알아보았다. 결과: 말기 AIDS 환자들에 대한 자원봉사 제공의향 정도 점수는 암환자에 대해서보다 평균 2.82점 낮았고 이는 통계적으로 유의하였다(P<0.001). 다중회귀분석 결과 자원봉사에 대한 만족도가 높을수록(P=0.002) '개인적인 낙인' 점수가 낮을수록(P<0.001) 말기 AIDS 환자들에 대한 자원봉사 제공의향 정도는 높아졌다. 결론: 본 연구의 결과 호스피스 자원봉사자들의 말기 AIDS 환자들에 대한 자원봉사 제공의향 정도와 관련이 있는 요인은 자원봉사에 대한 만족도와 AIDS에 대한 태도 중 '개인적인 낙인'이었다.

암환자를 위한 호스피스 케어에 관한 탐색적 연구 (An Exploratory Study of Hospice Care to Patients with Advanced Cancer)

  • 박혜자
    • 대한간호
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    • 제28권3호
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    • pp.52-67
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    • 1989
  • True nursing care means total nursing care which includes physical, emotional and spiritual care. The modern nursing care has tendency to focus toward physical care and needs attention toward emotional and spiritual care. The total nursing care is mandatory for patients with terminal cancer and for this purpose, hospice care became emerged. Hospice case originated from the place or shelter for the travellers to Jerusalem in medieval stage. However, the meaning of modem hospice care became changed to total nursing care for dying patients. Modern hospice care has been developed in England, and spreaded to U.S.A. and Canada for the patients with terminal cancer. Nowaday, it became a part of nursing care and the concept of hospice care extended to the palliative care of the cancer patients. Recently, it was introduced to Korea and received attention as model of total nursing care. This study was attempted to assess the efficacy of hospice care. The purpose of this study was to prove a difference in terms of physical, emotional a d spiritual aspect between the group who received hospice care and who didn't receive hospice care. The subject for this study were 113 patients with advanced cancer who were hospitalized in the S different hospitals. 67 patients received hospice care in 4 different hospitals, and 46 patients didn't receive hospice care in another 4 different hospitals. The method of this study was the questionaire which was made through the descriptive study. The descriptive study was made by individual contact with 102 patients cf advanced cancer for 9 months period. The measurement tool for questionaire was made by author through the descriptive study, and included the personal religious orientation obtained from chung(originated R. Fleck) and 5 emotional stages before dying from Kubler Ross. The content ol questionaire consisted in 67 items which included 11 for general characteristics, 10 for related condition with cancer, 13 for wishes far physical therapy, 13 for emotional reactions and 20 for personal religious orientation. Data for this study was collected from Aug. 25 to Oct. 6 by author and 4 other nurse's who received education and training by author for the collection of data. The collected data were ana lysed using descriptive statistics, $X^2-test$, t-test and pearson correlation coefficient. Results of the study were as follows: "H.C Group" means the group of patient with cancer who received hospice care. "Non H.C Group" means the group of patient with cancer who did not receive hospice care. 1. There is a difference between H.C Group and Non H.C Group in term of the number of physical symptoms, subjective degree of pain sensation and pain control, subjective beliefs in physical cure, emotional reaction, help of present emotional and spiritual care from other personal, needs of emotional and spiritual care in future, selection of treatment method by patients and personal religious orientation. 2. The comparison of H.C Group and Non H.C Group 1) There is no difference in wishes for physical therapy between two groups(p=.522). Among Non H.C Group, a group, who didn't receive traditional therapy and herb medicine was higher than a group who received these in degree of belief that the traditional therapy and herb medicine can cure their disease, and this result was higher in comparison to H.C Group(p=.025, p=.050). 2) Non H.C Group was higher than H.C Group in degree of emotional reaction(p=.050). H.C Group was higher than Non H.C Group in denial and acceptant stage among 5 different emotional stages before dying described by Kubler Ross, especially among the patient who had disease more than 13 months(p=.0069, p=.0198). 3) Non H.C Group was higher than H. C Group in demanding more emotional and spiritual care to doctor, nurse, family and pastor(p=. 010). 4) Non H.C Group was higher than H.C Group in demanding more emotional and spiritual care to each individual of doctor, nurse and family (p=.0110, p=.0029, P=. 0053). 5) H.C Group was higher th2.n Non H.C Group in degree of intrinsic behavior orientation and intrinsic belief orientation of personal religious orientation(p=.034, p=.026). 6) In H.C Group and Non H.C Group, the degree of emotional demanding of christians was significantly higher than non christians to doctor, nurse, family and pastor(p=. 000, p=.035). 7) In H.C Group there were significant positive correlations as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and: the degree of intrinsic behavior orientation in personal religious orientation(r=. 5512, p=.000). (2) Between the degree of emotional demandings to doctor, nurse. family & pastor and the degree of intrinsic belief orientation in personal religious orientation(r=.4795, p=.000). (3) Between the degree of intrinsic behavior orientation and the degree of intrinsic: belief orientation in personal religious orientation(r=.8986, p=.000). (4) Between the degree of extrinsic religious orientation and the degree of consensus religious orientation in personal religious orientation (r=. 2640, p=.015). In H.C. Group there were significant negative correlations as following; (1) Between the degree of intrinsic behavior orientation and extrinsic religious orientation in personal religious orientation (r=-.4218, p=.000). (2) Between the degree or intrinsic behavior orientation and consensus religious orientation in personal religious orientation(r=-. 4597, p=.000). (3) Between the degree of intrinsic belief orientations and the degree of extrinsic religious orientation in personal religious orientation(r=-.4388, p=.000). (4) Between the degree of intrinsic belief orientation and the degree of consensus religious orientation in personal religious orientation(r=-. 5424, p=.000). 8) In Non H.C Group there were significant positive correlation as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of intrinsic behavior orientation in personal religious orientation(r= .3566, p=.007). (2) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of intrinsic belief orientation in personal religious orientation(r=.3430, p=.010). (3) Between the degree of intrinsic behavior orientation and the degree of intrinsic belief orientation in personal religious orientation(r=.9723, p=.000). In Non H.C Group there were significant negative correlation as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of extrinsic religious orientation in personal religious orientation(r= -.2862, p=.027). (2) Between the degree of intrinsic behavior orientation and the degree of extrinsic religious orientation in personal religious orientation(r=-. 5083, p=.000). (3) Between the degree of intrinsic belief orientation and the degree of extrinsic religious orientation in personal religious orientation(r=-. 5013, p=.000). In conclusion above datas suggest that hospice care provide effective total nursing care for the patients with terminal cancer, and hospice care is mandatory in all medical institutions.

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End-of-Life Care Practice in Dying Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment For Patients in Hospice and Palliative Care or at the End of Life : A Single Center Experience

  • Jin, Sol;Kim, Jehun;Lee, Jin Young;Ko, Taek Yong;Oh, Gyu Man
    • Journal of Hospice and Palliative Care
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    • 제23권2호
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    • pp.93-102
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    • 2020
  • Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold life-sustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop life-sustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion: In many cases, the decision to discontinue life-sustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.

호스피스 간호에서 의미요법 적용을 위한 생의 의미 고찰 (Inquisition of Meaning in Life for Logotherapy Application in Hospice Nursing)

  • 최순옥;김숙남
    • 한국간호교육학회지
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    • 제9권2호
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    • pp.329-339
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    • 2003
  • The purpose of this study is to consider of meaning in life based on Frankl's theory and to propose of hospice nursing according to conceptual framework of meaning in life. The conceptual framework of meaning in life is composed of 4 phases. According to the first phase, acceptance & awareness of self and life, hospice nurse should helps dying patient to accept limitedness of human existence and death. and according to the second phase, actualization of creative value, hospice nurse can helps dying patient to discover meaning in life through doing a deed for last time before his death. According to the third phase, actualization of experiential value, hospice nurse can helps them to discovery of meaning by experiencing of love through meetings with other people, nature, and god. According to the forth phase, actualization of attitudinal value, hospice nurse can helps them to discovery of meaning by realizing meaning in suffering and death through exercising of the inner freedom to choose bravery and acceptance in the face of death and misfortune. As mentioned above, the Frankl's theory accords with the core of hospice nursing that helps people to accomplish human essence in suffering and death. therefore we accepted Frankl's point of view, asserted that one of the most important roles of a hospice nurse as a supporter and sustainer for dying patients is to help patients to find meaning in life even in the course of death. To achieve the goal, hospice nurses should try to have a firm faith through philosophical introspection about life, death, human existence and meaning in life what the most important goal of life is to discover meaning in life and human have the duty and responsibility of recognizing and pursuing meaning up to the last moment of life.

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병원 호스피스센터-보건소 연계를 통한 지역사회 재가암환자 관리 프로그램 평가 (Evaluation of a Community-Based Cancer Patient Management Program: Collaboration between a Hospice Center and Public Health Centers)

  • 이해숙;박선희;정영순;이부경;권소희
    • Journal of Hospice and Palliative Care
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    • 제13권4호
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    • pp.216-224
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    • 2010
  • 목적: 본 연구는 말기 재가암환자 관리를 위한 병원호스피스센터와 보건소 간의 연계 프로그램을 평가함으로써 보다 효율적이고 효과적인 재가암환자 관리체계를 구축하고자 시도되었다. 방법: 호스피스센터-보건소 재가암관리 연계 사업은 1) 협약체결, 2) 재가 말기암환자 발굴 및 등록, 3) 가정호스피스 방문 서비스 제공, 4) 만족도 조사의 단계로 전개되었다. 일 호스피스센터와 지역의 3개 보건소가 협약을 체결하였고, 2009년 2월 1일에서 12월 31일까지 11개월 동안 43명의 환자에게 605건의 가정호스피스 방문을 실시하였다. 방문기록지 분석을 통해 서비스 대상자의 특성과 제공된 서비스의 종류와 내용을 분석하였고, 이 중 20명에게 서비스 만족도 조사를 실시하였다. 결과: 대상자의 76.7%가 60세 이상이었고, ECOG 전신 수행상태 점수는 0점과 1점이 각각 37.2%, 39.5%이었다. 환자가 병식이 있는 경우는 90.7%, 호스피스 동의서에 서명한 경우는 62.8%였다. 초기방문 시 환자의 주 호소는 전신쇠약감(86.0%)과 식욕부진(72.1%)이 가장 많았다. 평균 총 서비스 기간은 144.42일이었고, 총 605건의 방문 중 간호사 방문이 371회로 가장 많았다. 각 방문중 정서적 지지와 건강상담이 가장 빈번하게 제공되었고, 서비스 전반에 대한 만족도는 5점 척도로 측정하였을 때 평균 4.45점이었다. 결론: 본 연구는 지역사회 내에서 실제적이고 체계적인 재가 말기암환자 관리 프로그램 구축을 위한 중간평가로서의 의미가 있다. 본 연구에서 의뢰된 대상자는 입원형 호스피스보다 기능 상태가 양호하고 서비스 제공기간이 길었으며, 서비스에 대한 만족도, 특히 정서적지지와 환자상태 설명에 대한 만족도가 높았다. 그러나 방문횟수와 빈도, 임종기 관리, 병원입원 재입원하는 환자관리에 대한 기준과 서비스 표준마련은 앞으로의 과제로 제시되었다.