Although most patients prefer dying at home, patients whose condition rapidly becomes critical need care in the intensive care unit (ICU), and it is rare for them to die at home with their families. Therefore, interest in hospice and palliative care for patients in the ICU is increasing. Hospice and palliative care (PC) is necessary for all patients with life-threatening diseases. The following patients need palliative care in the ICU: patients with chronic critical illnesses who need tracheostomy, percutaneous gastrostomy tube, and extracorporeal life support; patients aged 80 years or older; stage 4 cancer patients; patients with specific acute diseases with a poor prognosis (e.g., anoxic brain injury and intracerebral hemorrhage requiring mechanical ventilation); and patients for whom the attending physician expects a poor prognosis. There are two PC models-a consultative model and an integrative model-in the ICU setting. Since these two models have advantages and disadvantages, it is necessary to apply the model that best fits each hospital's circumstances. Furthermore, interdisciplinary decision-making between the ICU care team and PC specialists should be strengthened to increase the provision of hospice and palliative care services for patients expected to have poor outcomes and their families.
Purpose: The purpose of this study was to identify the needs of hospice care in families of the hospitalized patients with terminal cancer. Method: The data were collected from April to July, 2008. The participants were 100 family caregivers of hospitalized terminal patients with cancer recruited from two general hospitals in 2 cities in Korea. Needs of hospice care were measured using the 'Needs Assessment Instrument for Hospice Care in Families of the Patients with Cancer'. Results: The mean of needs score was 76.6, which meant degree of the needs was very high. Among the categories of the needs, the mean of category 'emotional care' was the highest. There were significant differences in the needs of hospice care according to sex and type of present therapy. Conclusion: Health care providers in hospital and hospice facilities must assess the needs of families as well as the patients in order to meet their specific needs. Additionally, they need to have deeper understanding of the need of emotional care and to apply emotional care to hopice patients and their families.
Palliative care is a comprehensive approach aimed at improving the quality of life for patients and their families. The symptom burden and care needs of patients with end-stage, non-malignant diseases are similar to those experienced by patients with advanced cancer. Therefore, the World Health Organization (WHO) has recommended the expansion of palliative care to encompass a broad spectrum of diseases. However, in Korea, the adoption of palliative care for non-malignant conditions remains markedly low, presenting numerous challenges that differ from those associated with cancer. Key barriers to implementing hospice care for non-malignant diseases include the difficulty in predicting end-of-life and a general lack of awareness about hospice palliative care among healthcare providers, patients, and their families. Additionally, there is a risk that suggesting palliative care to patients with non-malignant diseases might be misinterpreted as an endorsement by healthcare providers to cease treatment or abandon the patient. This article explores strategies to broaden the scope of hospice and palliative care for patients with non-malignant diseases.
The urgent needs to establish hospice care systems in Korea arise from the following reasons: 0) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e. g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accomodate other medical insurance beneficiaries; (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life; (6) medical and nursing care of AIDS patient in terminal stage; (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage. grouped in hospice and non-hospice care patients. reveal what they want visiting nursing care to help their pain control. psychological. social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains. the non-hospice care patients. in addition to their desire for pain control. demanded more psychological. social and spiritual helps as well. The results of this research could be utilized to 0) define the standard of hospice care. (2) provide the guidance for hospice medical care costs. (3) establish the database of hospice care systems. (4) develop softwares. (5) build communication network through Medinet. and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy. nursing care. and social welfare programs.
The purpose of the study was to compare home care nursing intervention activities analyzed by the Nursing Intervention Classification (NIC) system for hospice and general patients. Method: For the descriptive survey study, data was collected by reviewing charts of 151 hospice patients and 421 general patients who registered in the department of home health care nursing at K Hospital. Results: According to the NIC system application, there were 2380 total nursing interventions used for the hospice patients and 8725 for the general home care patients. For both sets of patients (hospice vs. general), the most frequently used nursing intervention in level 1 was the Physiological: Complex domain (40.13 vs. 31.06 percent), followed by the Safety domain; in level 2, the Risk Management class (28.4 vs. 27.70 percent), followed by Tissue Perfusion Management; and in level 3, Vital Sign Monitoring (6.18 vs. 4.84 percent), followed by Health Screening. Conclusion: The study showed that there was a lack of specialized hospice nursing interventions such as emotional, family and spiritual support, and care for dying hospice patients.
This paper has surveyed above all what the patients call for physically, psychologically, and socially and researched how the ministers have acknowledge on cancers, their patients and hospice by means of enquete. To the difficulty the pastors should give their hands. This study researched what thoughts and behaviors the ministers actually had by the method of questionnaire. It was done from October 20, 1997 through December 10, 1997 on seven thousand of questionnaire paper of which 149 given back on the line of post or firsthandly were analyzed. The questioness consisted of 141 men(94.6%), 8 women(5.4) and 104 pastor on appentice(69.8%). There were 58 questionees(38.9%) who were hospitalized of their own diseases, and 121 questionees(81.3%) who had cancer patients hospitalized among their church people, relatives, or friends. Most of all the questionees(79.9%) had not any experience, such as they took some instruction about cancer patients. 72.5% of all the questionees had not ever served patients around them. The followings are the contents of the enquete: the questionees' view to chronic patients and death, where they put the priority in the case of that they look after patients who are under terrible pain ahead of death, what they think of such a situation as a patient has no technical possibility to be recuperated, why they think pastors do not like to visit chronics, which therapy they choose, whether they mainly control their pain or they do their best in order to heal their diseases, how much the questioned ministers know hospice, where and how they get the information on it, how much important role they play in the hospice team, whether the volunteers for hospice have not worked on account of pastors' misunderstanding to hospice service, whether the ministers want to take part in hospice service with their church people or not, and so forth. Suggestion: First, the education and P.R. about hospice are requested for the ministers. Second, the ministers must participate in hospice activities actively. Therefore the ministers and the churches must firsthandly take part in hospice activities beyond the education only and the raising of the recognition to them.
Purpose: The purpose of this study was to compare the spiritual well-being and quality of life between hospital and home hospice patients. Methods: A total of 116 patients from 4 hospice hospitals in D city and P city participated in this study from January to April 2012. To measure spiritual well-being, an instrument developed by Paloutzian and Ellison (1982) and revised by Park (2005) was used. To measure quality of life, an instrument developed by Cho (1993) and revised by Sun (2003) was used. The data were analyzed by using descriptive statistics, t-test, $x^2$-test, and ANCOVA. Results: Spiritual well-being and quality of life were higher in home hospice patients than in hospital hospice patients, but they were not statistically significant. Higher education and having religion were significantly related to higher spiritual well-being in both groups. Having religion and pain history for the past one week were significantly related to higher quality of life in both groups. Conclusion: For hospice patients, participation in religious activities needs to be encouraged to improve their spiritual well-being and quality of life. Assessing the hospice patients' pain history with close observation and managing the pain are suggested.
As Korea has just turned into an aging society with the increase of average life expectancy, and the main causes of deaths is cancer and other chronic diseases. And this corresponds to a dramatic increase in medical expenses for the aged. To curve this problem, the hospice care can be an effective alternative, which can provide patients with both quality service and intensive care to help ensure high quality life for the patients. To demonstrate the economical effect of hospice services, a comparative study on the media expenses of geriatric hospitals and general hospitals, which bear similarities in common regarding the characteristics of their patients, is performed. Thus the results of the study can serve as a quantitative indication for the management of hospice services.
Purpose: The purpose of this study is to develop a set of standardized nursing interventions and their associated nursing activities according to the NIC system to guide home care nurses in performing nursing intervention activities for hospice patients. Method: This study was a descriptive survey that first identified frequently used & specialized hospice nursing interventions based on the NIC systems and next validated a set of standardized nursing interventions and their associated nursing activities. One hundred chart records of home hospice patients were used to identify nursing interventions. Also, thirty-nine hospice specialized nurses participated twice using the Delphi technique to test the content validity of the standards. Results: Among the nursing interventions, 19 important nursing interventions and 418 associated nursing activities were selected after two rounds of Delphi technique by hospice specialized nurses. The mean content validity of the final nursing activities was 0.82. In this paper, only the 3 most frequently used nursing interventions and 3 hospice specialized nursing interventions with their associated nursing activities are presented since space is limited. Conclusion: The nursing intervention standards will be a basis for home hospice nurses to improve quality of hospice care for hospice patients.
In Korea, there are constantly increasing number of cancer patients with reaching 65,000 deaths and it was 26.3% of the total number of death in 2004. Many cancer patients suffer from surgery, chemotherapy, and radiotherapy after being diagnosed as cancer. And many of them are facing fear of death because they can't be perfectly cured. Due to patients' physical, psychological, and spiritual pain, quality of life drops dramatically. Patients' families also suffer from huge medical expenses while they have to take care of patients's suffering from pain. At the same time, family's attitude can influence on the quality of patients' life. The purpose of this study is to investigate the relationship between the death orientation of first care giver and the quality of life of hospice patient. The subjects of the study were 80 hospice patients registered at ten hospice institutions with hospice team and medical practitioners in six cities including Seoul as well as their first care givers. This study used 13 questions for the hospice patients and nine questions for the first care givers to recognize general characteristic. To measure death orientation of the first care giver the tool developed by Noh, Soon-hee (2003) was used. And to measure quality of life of the hospice patients Yoo, Seung-yeon's structured tool was used. The data were collected for a month through interview method. SPSS win 12.0 was used to analyze the data by using frequency, percentage, t-test, Pearson correlation. The study result is as follows. In relationship between general characteristic of hospice patient and quality of life, the highest suffering was pain (60%) and the second suffering was anorexia (23.8%). There was no significant relationship between physical pain and general characteristics of hospice patient. In psychological aspects, religion (p=.044) showed significant difference (p<.05). In existential aspects, age (p=.035) showed significant difference (p<.05). There was no significant difference variable in support aspects. And religion (p=.000) was statistically significant variable in spiritual aspects (p<.001). Age (p=0.025) and religion (p=.050) were the variable showed significant difference according to general characteristics of first care giver's death orientation. Although the relation between death orientation of first care giver and quality of life of hospice patient was not statistically significant correlation. In conclusion, while death orientation of first care giver and hospice patient's quality of life are not statistically significant in correlation analysis.
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