• Journal of Hospice and Palliative Care
• /
• v.12 no.4
• /
• pp.199-208
• /
• 2009

Purpose: The purpose of this study was to analyze the effect of death preparing education on death anxiety and meaning of life for volunteers. Methods: Data collection and intervention were carried out from January 11 to 25, 2009. The subjects included 60 volunteers in Jeonju city, and they were divided into two groups; 30 each of experimental group and control group. Death preparing education program contained 5 steps. Data were analyzed with t-test, $x^2$-test, and ANCOVA test with SPSS version 12.0. Results: The death anxiety scores in the experimental group were significantly lower than in the control group (F=4.01, P=0.046). The meaning of life scores in the experimental group were significantly higher than in the control group (F=6.32, P=0.015). Conclusion: The death preparing education program for volunteers was confirmed to be an effective intervention to lessen death anxiety and to improve the meaning of life. Therefore, I strongly recommend that this program should generously be applied to volunteers.

• Journal of Hospice and Palliative Care
• /
• v.11 no.3
• /
• pp.140-146
• /
• 2008

Purpose: Sooner of later, end-of-life care decision-making will unfold and be settled during the professional lives of medical students. However, there is prevalent ambiguity and uncertainty between the palliative treatment and euthanasia. We conducted this survey to investigate attitudes of medical students towards end-of-life making decisions, and to find out which factors primarily influenced the attitudes. Methods: A study was conducted among medical students at one university, the Republic of Korea. A written questionnaire was sent to all the 1st, 2nd, and 3rd-year medical students. It presented 5 statements on end-of-life decision-making. Students were asked whether they agreed or disagreed with each statement. Results: The response rate was 74.4%, and 267 questionnaires were analyzed. Percentages of agreement with each statements on Voluntary active euthanasia (VAE), Physician assisted suicide (PAS), Withholding life-sustaining management, Withdrawing life-sustaining management, and Terminal sedation (TS) was 37.1%, 21.7%, 58.4%, 60.3%, and 41.6%, respectively. The grade of students, religious activity, and educational experience were determinant factors. Agreement on each statements was higher in the low religious activity group than in the high religious activity group. Agreement on TS was higher among 3rd year students during their clerkship than among 1st and 2nd year students. Age of students and the experience of dying-people care had no significant influence. Conclusion: In end-of-life decision-making, religious and educational factors influenced medical students' attitudes. Especially, the experience of education during clerkship had significant influence on the attitude. Proper teaching on end-of-life decisions should further be considered during medical students' clerkship.

• Journal of Hospice and Palliative Care
• /
• v.20 no.1
• /
• pp.46-57
• /
• 2017

Purpose: The purpose of this study is to identify the changes to nursing activities of nurses on patients with DNR (Do-Not-Resuscitate) order and factors associated to the changes. Methods: Data were collected using a structured questionnaire for 173 nurses at general hospitals. Logistic regression analysis was performed on the data using SAS 9.4. Results: With 39 nursing activities, an average of 60.4 (34.9%) nurses reported an increase in the activities, 102.4 (59.2%) no change and 10.1 (5.9%) a drop. The activity increase was the greatest in the social area, and the physical area was where the activities decreased the most. The activity increase was associated knowledge competency (9 items), attitudes (2 items), practical competency (4 items) and work load (14 items were). Conclusion: To offer systematical care for DNR patients, it is necessary to expand nurses' knowledge through end-of-life education and adjust their workload and provide a support system at the department level.

• Korean Journal of Hospice Care
• /
• v.2 no.2
• /
• pp.28-48
• /
• 2002

The advances of medical technologies have not only prolonged human life span, but also extended suffering period for the patients with incurable medical diseases. Hospice movement was developed to help these patients keep dignity and lives peaceful at the end of their life. Since many patients prefer to spend the last moment of life at home with their family, hospice home care has become very popular worldwide. The purpose of this study for a promotion and development of hospice home care in Korea, and features basic research on medical profession's knowledge and attitudes to hospice home care. This study which was used for the research questionnaires developed by the researcher that were answered by 100 physicians and 127 nurses in a general hospital. Data were collected from April 22, 2002 to May 10, 2002. The SPSS was used to make a comparative analysis of the frequency, percentile, ANOVA, and x2-test. The results of the study were as follows; 1.The medical profession showed high level of knowledge of the definition and philosophy of hospice. However, the physician group of the examinees showed insufficient knowledge of the fact that hospice care includes bereavement care, while the nurse group's response to the same question showed a significant difference(x2=10.752, p=.001). 2.For whom the hospice home care is provided, 95.6% of the respondents showed very high level of knowledge as answering that the incurable terminal illness patients and their families are the beneficiaries of hospice care. The respondents counted nurses, volunteers, pastors, physicians and social workers, consecutively, as hospice care providers. More nurse were positive toward pastors than physicians in regarding as a hospice care provider by a significant difference(x2=11.634, p=.001). 3.For when to referral hospice home care to the patients, only 34.2% answered that patients with less than 6 months of survival time are advised to receive hospice care, reflecting very low level of knowledge. 23.0% of the physicians and 48.0% of the nurses answered that hospice care should be provided when death is imminent, making a significant difference between the two groups(x2=6.413, p=.000). 4.To promote hospice activities, 87.2% pointed out that it is crucial to make general people, including those engaging in the medical field, more aware of hospice. 79.7% answered that a national hospice management should be developed, marking a significant difference between the physician group and nurse group(x2=10.485, p=.001). 5.Advantages of hospice home care are 87.2% responded that patients can have better rest at home receiving hospice home care. Economical merit was brought forward as one of the advantages also, where there was a significant difference between the physicians group and nurse group(x2=7.009, p=.008). 6.The medical professions' attitude to hospice home care are 92.8% of the physicians answered that they would advise incurable terminally ill patients to be discharged from hospital, with 44.3% of them advising the patients to receive hospice home care after leaving the hospital. From the nurses' point of view, 20.9% of the terminally ill patients are being referred to hospice home care after discharge, which makes a significant difference from the physicians' response(x2=19.121, p=.001). 7. 30.6% of physicians have referred terminally ill patients to hospice home care, 75.9% of whom were satisfied with their decision. Those physicians who have never referred their patients to hospice home care either did not know how to do it(66.7%) or were afraid of losing trust by giving the patients an impression of giving up(27.3%). 94.9% of the physicians responded that they would refer their last stage patients to a doctor who is involving palliative care. 8.Only 36.2% of nurses have suggested to physicians that refer the terminally ill patients discharged from the hospital to hospice home care. Once suggested, 95.8% of the physicians have accepted the suggestion. Nurses were reluctant to suggest hospice home care to the physicians, as 48.8% of the nurses said they did not want to. From the result of this study the following conclusion can be drawn, the medical profession's awareness of general hospice care has been increased greatly compared to the results of the previously performed studies. However, this study result also shows that their knowledge of hospice home care is not good enough yet. There is a need for high recommended that medical education institute and develop regular courses on various types of hospice care. Medical field training courses for physicians and nurses will be very helpful as well. It is also important to train hospice experts such as palliative physicians and develop a national hospice management urgently in order to improve the hospice care in Korea.

• Journal of Hospice and Palliative Care
• /
• v.19 no.2
• /
• pp.136-144
• /
• 2016

Purpose: To provide practical data for bioethics education, we identified correlations between recognition of good death, attitude towards withdrawal of meaningless life-sustaining treatment, and attitude towards euthanasia in nurses. Methods: Using convenience sampling, we recruited 218 nurses who had at least six-month work experience in one of the six general hospitals with 500 or more beds in Seoul, Busan, and Gyeongsang province. All participants understood the purpose of the study and agreed to take part in the study. The research tools used included the Concept of Good Death Measure (CoGD), the measurement tool for attitudes towards withdrawal of meaningless life-sustaining treatment (WoMLST), and the measurement tool for attitudes towards euthanasia. Data were analyzed using an Independent t-test, one-way ANOVA, and Pearson's correlation coefficient using SPSS 21 for Windows. Results: Nurses had normal levels on CoGD, WoMLST, and attitudes towards euthanasia. Nurses' CoGD, WoMLST, and euthanasia scores significantly differed depending on their education level, working period, and the importance of religion to them. A negative correlation was found between the CoGD and WoMLST scores, and WoMLST and euthanasia scores were positively correlated. Conclusion: Nurses should be trained to deal with ethical issues that may arise while caring for terminal patients. It is necessary for nurses to understand the concepts related to CoGD, WoMLST, and euthanasia, and to promote bioethics education with focus on decision-making and problem-solving ability in ethically conflicting situations.

• Journal of the Korean Society of School Health
• /
• v.28 no.2
• /
• pp.120-126
• /
• 2015

Purpose: The purpose of this study was to understand interpersonal dispositions and social support among high school students and identify factors associated with depression. Methods: A total of 604 students (320 males and 284 females) from four high schools conveniently sampled from high schools in the Incheon area participated in a self-administered survey. Results: According to hierarchical multiple regression analysis, the following factors significantly affected the participants' depression levels with the explanatory power of 30.6%: grade, perceived health status, sympathetic-acceptable personality, sociable-friendly personality, rebellious-distrustful personality, parent support, peer support, and the support from community. Conclusion: In this study, interpersonal dispositions and social support were positively associated with depression. These results suggest that strengthening personal relations and social support can help high school students in terms of mental health and suicide prevention.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.12
• /
• pp.4885-4891
• /
• 2014

Background: Successful implementation of pain management procedures and guidelines in an institution depends very much on the acceptance of many levels of healthcare providers. Aim: The main purpose of this study was to determine the level of knowledge and attitudes regarding pain among nurses working in tertiary care in a local setting and the factors that may be associated with this. Materials and Methods: This cross-sectional research study used a modified version of the Nurses' Knowledge and Attitudes Survey (NKAS) regarding pain. Basic demographic data were obtained for further correlation with the level of pain knowledge. Results: A total of 566 nurses, 34 male and 532 female, volunteered to participate in this study. The response rate (RR) was 76%, with an overall mean percentage score of $42.7{\pm}10.9$ (range: 5-92.5). The majority of participants were younger nurses below 40 years of age and more than 70% had worked for less than 10 years ($6.6{\pm}4.45$). Up to 92% had never had any formal education in pain management in general. The total mean score of correct answers was $58.6{\pm}9.58$, with oncology nursing staff scoring a higher percentage when compared with nurses from other general and critical care wards ($63.52{\pm}9.27$, p<0.045). Only 2.5% out of all participants obtained a score of 80% or greater. The majority of the oncology nurses achieved the expected competency level (p<0.03). Conclusions: The present findings give further support for the universal concern about poor knowledge and attitudes among nurses' related to the optimal management of pain. The results reflected that neither number of years working nor age influenced the level of knowledge or attitudes of the practising nurses. Oncology nursing staff consistently scored better than the rest of the cohort. This reflects that clinical experience helped to improve attitudes and knowledge concerning better pain management.

• 한국호스피스완화의료학회:학술대회논문집
• /
• 2000.12a
• /
• pp.162-174
• /
• 2000

The purpose of this hermeneutic study was to investigate the meaning of "good dying" of Chinese terminally ill cancer patients in Taiwan; the factors related to this morning; and the strategies cancer patients used to ensure "good dying". Indepth unstructured interviews, prolonged participant observations, and review of clinical records were selected as the methods for data collection. In the four and one-half month period of data collection, the researcher was in the role of a full time clinical nurse specialist who directly took care of the subject patients in 4 hospitals and in patients' homes. The 20 subject were selected purposively according to selection criteria and various demographic backgrounds. Interview transcripts and field notes comprised the data for analysis. The results were composed by 3 constitutive patterns and 12 themes. Achieving inner peace appeared to herald the good dying state. The "good dying" for Chinese terminally ill cancer patients in Taiwan meant peace of body, peace of mind, and peace of thought. The constitutive pattern of peace of body included 4 themes: (1)minimizing the agony of physical symptoms; (2)short period of dying process without lingering death; (3) cleanliness, neatness, and integrity of the body; and (4) mobility. The constitutive pattern of peace of mind included 5 themes: (1) yielding; (2) non-attachment; (3) not to be lonely; (4) settle down all affairs; and (5) being in a preferred environment and enjoying nature. The third constitutive pattern of peace of thought included 3 themes: (1) getting through day by day without thinking; (2) meaningful life; and (3) expectation that the suffering would be ending. Through understanding of the terminally ill cancer patient' needs in their meanings of "good dying", recommendations can be made for humanistic care. The findings of this study have recommendations for care givers daily contact with dying patients and for medical and nursing education.

• Journal of Hospice and Palliative Care
• /
• v.18 no.1
• /
• pp.25-34
• /
• 2015

Purpose: This study is to find relationship between cancer patient's spiritual health and the level of their anxiety and pain. Methods: From April 27 through May 11, 2012, a survey was conducted with 167 cancer patients hospitalized at a university hospital in Busan. Spiritual health was measured by the Spiritual Health Inventory developed by Highfield (1992). The instrument for anxiety measurement was the State-Trait Anxiety Inventory by Spielberger (1975) and that for pain was the Visual Analogue Scale (2009). The association between patients' characteristics and spiritual health, anxiety or pain degree were analyzed using the ANOVA test. The interrelationship between spiritual health, anxiety and pain was analyzed using Pearson's correlation coefficients. Results: The patients exhibited a moderate degree of spiritual health and anxiety and a mild level of pain. Patients' spiritual health significantly differed by their religion, education, monthly income of the family, illness conditions, physical conditions, metastasis, daily living and support. Their anxiety level was significantly different according to age, religion, education, illness conditions, physical conditions, metastasis, daily living, family/friends' support and use of analgesics. Significant differences were also found in the level of pain according to illness conditions, physical conditions, metastasis, daily living, family/friends' support and use of analgesics. We found a moderately negative correlation between spiritual health and anxiety. Anxiety and pain showed a positive correlation, and spiritual health and pain exhibited a negative correlation. Conclusion: To help cancer patients to manage their spiritual health, anxiety and pain, a program should be developed considering the primary factors discussed in this study.

• Journal of Hospice and Palliative Care
• /
• v.11 no.2
• /
• pp.91-98
• /
• 2008

Purpose: This study was undertaken to compare perceived stress and coping patterns, and their effects on depression between cancer patients and healthy adults. Methods: A descriptive design was used with 278 subjects, consisting of 139 cancer patients and 139 health adults, living in an urban area. All participants completed the following prerequisites; Stress Visual Analog Scale, Ways of Coping Checklist (W.C.C.L), Depression Index (CES-D), and Demography and Disease Data Questionnaire. Results: Perceived stress and depression were significantly higher, while wishful thinking was lower among cancer patients than healthy adults, after adjusting for education and family income which were not homogeneous between the groups. Among cancer patients, 20.2% of depression was mainly due to seeking support (10.7%), perceived stress and education, while 30.7% of depression in healthy adults was due to perceived stress, problem solving, and seeking support. Conclusion: These findings suggest that interventions to manage depression in cancer patients should include strategies to best foster positive coping patterns and reduce perceived stress.