• Journal of East-West Nursing Research
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• v.27 no.2
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• pp.124-133
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• 2021

Purpose: This study examined the effects of death perception, terminal care stress, and resilience on the terminal care performance of clinical nurses. Methods: As a correlational study, this study conducted a survey total of 189 nurses working at K university hospital and a P university hospital in B metropolitan city for six months or more. The data was collected from August 20th, 2020 to September 15th, 2020. Data were analyzed using the SPSS, Windows version 25.0, according to the purpose of the analysis by descriptive statistics, t-test, ANOVA, Scheffe test, Pearson's correlation coefficient, and hierarchical multiple linear regression. Results: The factors having effects on the terminal care performance of subjects were resilience, perception of death, and the experience of terminal care education. The total explanatory power of those variables on the terminal care performance was 21.0%. Conclusion: For the improvement of terminal care performance, it would be necessary to develop a systematic and professional terminal care education program that could increase the positive perception of death and resilience, and also include knowledge and skills necessary for terminal care. Also, the efficiency of terminal care performance should be increased through periodic terminal care-related nursing education.

• Journal of Hospice and Palliative Care
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• v.23 no.4
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• pp.172-182
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• 2020

Purpose: This study aimed to identify the relationships among attitudes towards death, perceptions of hospice care, and hospice care needs as perceived by family members of patients in the intensive care unit (ICU). Methods: This study used a descriptive correlational method. A structured questionnaire was used to collect data from 114 participating families in the ICU at Dong-A University Hospital, from October 10 to November 1, 2019. The data were analyzed in terms of frequency, percentage, and mean and standard deviation. The t-test, one-way analysis of variance, and Pearson correlation coefficients were also conducted. Results: Perceptions of hospice care showed significant differences according to age (F=3.06, P=0.031) and marital status (t=3.55, P=0.001). However, no significant differences in attitudes towards death or hospice care needs were found. A significant positive correlation was found between perceptions of hospice care and hospice care needs (r=0.49, P<0.001). Conclusion: In order for families to recognize the need for hospice care and to receive high-quality palliative care at the appropriate time, it is necessary to increase public awareness of hospice care through various educational and awareness-raising efforts, thereby providing opportunities for families of terminally ill patients to request hospice care.

• Journal of Hospice and Palliative Care
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• v.26 no.2
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• pp.80-94
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• 2023

Purpose: This study aimed to identify attitudes toward advance directives (ADs) among female cancer patients and factors related to ADs. Methods: The study was conducted at a university hospital in Seoul from September 19, 2020, to January 20, 2021. The participants were 153 patients diagnosed with gynecological cancer or breast cancer. Data were collected using questionnaires and included general characteristics, disease- and AD-related characteristics, knowledge and attitudes about ADs, and attitudes about dignified death. Data were analyzed using the t-test, analysis of variance, and multiple regression analysis. Results: Only 2% of the participants completed ADs. The mean score for attitudes toward ADs was 3.30, indicating a positive knowledge and attitude toward dignified death. The factors related to attitudes toward ADs were attitudes toward dignified death (𝛽=0.25, P=0.001), experience discussing life-sustaining treatment (𝛽=0.17, P=0.037), preferred time to have a consultation about ADs (𝛽=0.19, P=0.046), intention to write ADs (𝛽=0.15, P=0.038), and Eastern Cooperative Oncology Group Performance Status (𝛽=-0.37, P<0.001). The explanatory power of these variables for attitudes toward ADs was 38.5%. Conclusion: Overall, patients preferred to have a consultation about ADs when they were still active, mentally healthy, and able to make decisions. Education about ADs should be provided to patients on the first day of hospitalization for chemotherapy or while awaiting treatment in an outpatient setting so patients can write ADs and discuss them with family and friends.

• Journal of Korean Academy of Nursing
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• v.42 no.5
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• pp.680-688
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• 2012

Purpose: The purposes of this study were to explore the effects of family cohesion and subjective happiness on death anxiety of Korean elders and to identify other factors contributing to death anxiety. Methods: The participants were 280 elders who lived in P metropolitan city. Data were collected between November 5, 2011 and January 12, 2012 using the Short Portable Mental Status Questionnaire (SPMSQ), Family Cohesion Evaluation Scale, Subjective Happiness Scale, and Fear of Death Scale (FODS). Data were analyzed using the SPSS/WIN 19.0 program. Results: Family cohesion, marital status, religious activity, perceived health status, and subjective happiness were included in the factors affecting death anxiety of Korean elders. These variables explained 50.1% of death anxiety. Conclusion: The results of the study indicate that these variables should be considered in developing nursing intervention programs to decrease death anxiety and increase family cohesion and subjective happiness for life integration in Korean elders.

• BMB Reports
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• v.35 no.1
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• pp.67-86
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• 2002

Three routes have been identified triggering neuronal death under physiological and pathological conditions. Excess activation of ionotropic glutamate receptors cause influx and accumulation of $Ca^{2+}$ and $Na^+$ that result in rapid swelling and subsequent neuronal death within a few hours. The second route is caused by oxidative stress due to accumulation of reactive oxygen and nitrogen species. Apoptosis or programmed cell death that often occurs during developmental process has been coined as additional route to pathological neuronal death in the mature nervous system. Evidence is being accumulated that excitotoxicity, oxidative stress, and apoptosis propagate through distinctive and mutually exclusive signal transduction pathway and contribute to neuronal loss following hypoxic-ischemic brain injury. Thus, the therapeutic intervention of hypoxic-ischemic neuronal injury should be aimed to prevent excitotoxicity, oxidative stress, and apoptosis in a concerted way.

• Journal of Korean Critical Care Nursing
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• v.9 no.2
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• pp.61-70
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• 2016

Purpose: The purpose of this study was to identify the influences of death perception, terminal care attitude on clinical nurses' terminal care performance for cancer patients. Methods: Data were collected through self-reported questionnaires filled by 526 nurses at a General Hospital in Seoul. Data were analyzed using a multiple regression analysis. Results: Death perception showed a positive correlation with terminal care attitude (r = .45, p < .001), while there was no correlation with terminal care performance. Additionally, terminal care attitude had a positive correlation with terminal care performance (r = .18, p < .001). The explanatory power of nurses' death perception and terminal care attitude toward terminal care performance was 14%. Conclusions: The study results imply that nurses' death perception and terminal care attitude are significant variables affecting terminal care performance.

• Annals of Occupational and Environmental Medicine
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• v.34
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• pp.40.1-40.9
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• 2022

Background: According to the occupational accident status analysis in 2020, of 1,180 occupational deaths, 463 were caused by cardiovascular disease (CVD). Workers should be assessed for CVD risk at regular intervals to prevent work-related CVD in accordance with the rules on occupational safety and health standards. However, no previous study has addressed risk and mortality. Therefore, this longitudinal study was conducted to evaluate the relationship between 10-year cardiovascular risk of the general health checkup and mortality. Methods: The study included 545,859 participants who visited Kangbuk Samsung Total Healthcare Centers from January 1, 2002, to December 31, 2017. We performed 10-year cardiovascular risk assessment for the participants and the risk was divided into 4 groups (low, moderate, high, and very high). The study used death data from the Korea National Statistical Office for survival status as an outcome variable by December 31, 2019, and the cause of death based on the International Classification of Diseases, 10^th Revision (ICD-10) was identified. Statistical analysis was performed using Cox proportional hazards regression analysis, and the sum of the periods from the first visit to the date of death or December 31, 2019, was used as a time scale. We also performed a stratified analysis for age at baseline and sex. Results: During 5,253,627.9 person-years, 4,738 overall deaths and 654 cardiovascular deaths occurred. When the low-risk group was set as a reference, in the multivariable-adjusted model, the hazard ratios (HRs) (95% confidence interval [CI]) for overall mortality were 3.36 (2.87-3.95) in the moderate-risk group, 11.08 (9.27-13.25) in the high-risk group, and 21.20 (17.42-25.79) in the very-high-risk group, all of which were statistically significant. In cardiovascular deaths, the difference according to the risk classification was more pronounced. The HRs (95% CI) were 8.57 (4.95-14.83), 38.95 (21.77-69.69), and 78.81 (42.62-145.71) in each group. As a result of a subgroup analysis by age and sex, the HRs of all-cause mortality and cardiovascular mortality tended to be higher in the high-risk group. Conclusions: This large-scale longitudinal study confirmed that the risk of death increases with the 10-year cardiovascular risk of general health checkup.

• Korean Circulation Journal
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• v.52 no.7
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• pp.544-555
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• 2022

Background and Objectives: The outcome benefits of β-blockers in chronic coronary artery disease (CAD) have not been fully assessed. We evaluated the prognostic impact of β-blockers on patients with chronic CAD after percutaneous coronary intervention (PCI). Methods: A total of 3,075 patients with chronic CAD were included from the Grand Drug-Eluting Stent registry. We analyzed β-blocker prescriptions, including doses and types, in each patient at 3-month intervals from discharge. After propensity score matching, 1,170 pairs of patients (β-blockers vs. no β-blockers) were derived. Primary outcome was defined as a composite endpoint of all-cause death and myocardial infarction (MI). We further analyzed the outcome benefits of different doses (low-, medium-, and high-dose) and types (conventional or vasodilating) of β-blockers. Results: During a median (interquartile range) follow-up of 3.1 (3.0-3.1) years, 134 (5.7%) patients experienced primary outcome. Overall, β-blockers demonstrated no significant benefit in primary outcome (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.63-1.24), all-cause death (HR, 0.87; 95% CI, 0.60-1.25), and MI (HR, 1.25; 95% CI, 0.49-3.15). In subgroup analysis, β-blockers were associated with a lower risk of all-cause death in patients with previous MI and/or revascularization (HR, 0.38; 95% CI, 0.14-0.99) (p for interaction=0.045). No significant associations were found for the clinical outcomes with different doses and types of β-blockers. Conclusions: Overall, β-blocker therapy was not associated with better clinical outcomes in patients with chronic CAD undergoing PCI. Limited mortality benefit of β-blockers may exist for patients with previous MI and/or revascularization.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.9
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• pp.270-278
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• 2019

This study is a preliminary survey to determine the desired demanding well-dying education requirements for subjects aged 65 years or older according to their family's death experience. The results of this study report that all subjects needed well-dying education regardless of their family's death experience. In addition, 71.8% of those who had experienced family deaths said they needed education. On the other hand, 40% of those with no family deaths said that education was needed. Both groups responded as needing well-dying education based on the meaning of death and value of life. Groups with family death experiences hoped to include 'how to overcome sadness related to the death of family and friends' and 'information about organ or body donation procedures'. Both groups responded that 1 week was appropriate for the duration of well-dying education, and that the lectures and discussions were appropriate for the education method. In the future, well-dying education will require sustainable education, not one-offs, and education for the family as well as the elderly.

• Journal of the Korea Convergence Society
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• v.10 no.8
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• pp.37-44
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• 2019

The purpose of this study is to determine the inhibiting factors of dying well for people who want to have a good death. The final respondents in this study were sampled using stratified proportional allocation using a stratified random sampling method, and 1,000 adults aged between 19 and 75 years were selected. The questionnaire used consisted of four items on general characteristics and 20 items related to the inhibiting factors of dying well scored on a 7-point Likert scale. Analysis was conducted using descriptive statistics, correlation analysis, and decision tree analysis. Results showed that, among the inhibiting factors of dying well, "degenerative diseases (such as dementia)" and "loss of control (mental / physical)" scored 5.502 and 5.268 points, respectively; the highest significant positive correlation was found between "bad marital relationship" and "bad relationship with children," followed by "did not receive death education" and "lack of medical policy promotion (dying well)" and "bad relationship with children" and "indifference of others." Considering these findings, it appears that the whole society will make efforts to improve the perception and practice of good death, and life and death education will be expanded if death education for dying well is organized and implemented.