• Title/Summary/Keyword: hospice patients

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Spiritual Care in Hospice and Palliative Care

  • Ferrell, Betty R.
    • Journal of Hospice and Palliative Care
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    • v.20 no.4
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    • pp.215-220
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    • 2017
  • Spiritual care is at the center of hospice and palliative care. Patients facing serious and life-threatening illness have important needs in regard to faith, hope, and existential concerns. The purpose of this article is to review the key aspects of this care, including the definitions of spirituality, spiritual assessment, and spiritual care interventions. A review of the current literature was conducted to identify content related to spiritual care in hospice and palliative care. A growing body of evidence supports the importance of spiritual care as a key domain of quality palliative care. The literature supports the importance of spiritual assessment as a key aspect of comprehensive patient and family assessment. Spirituality encompasses religious concerns as well as other existential issues. Future research and clinical practice should test models of best support to provide spiritual care.

Determination of Cost and Measurement of nursing Care Hours for Hospice Patients Hospitalized in one University Hospital (일 대학병원 호스피스 병동 입원 환자의 간호활동시간 측정과 원가산정)

  • Kim, Kyeong-Uoon
    • Journal of Korean Academy of Nursing Administration
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    • v.6 no.3
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    • pp.389-404
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    • 2000
  • This study was designed to determine the cost and measurement of nursing care hours for hospice patients hostpitalized in one university hospital. 314 inpatients in the hospice unit 11 nursing manpower were enrolled. Study was taken place in C University Hospital from 8th to 28th, Nov, 1999. Researcher and investigator did pilot study for selecting compatible hospice patient classification indicators. After modifying patient classification indicators and nursing care details for general ward, approved of content validity by specialist. Using hospice patient classification indicators and per 5 min continuing observation method, researcher and investigator recorded direct nursing care hours, indirect nursing care hours, and personnel time on hospice nursing care hours, and personnel time on hospice nursing care activities sheet. All of the patients were classified into Class I(mildly ill), Class II (moderately ill), Class III (acutely ill), and Class IV (critically ill) by patient classification system (PCS) which had been carefully developed to be suitable for the Korean hospice ward. And then the elements of the nursing care cost was investigated. Based on the data from an accounting section (Riccolo, 1988), nursing care hours per patient per day in each class and nursing care cost per patient per hour were multiplied. And then the mean of the nursing care cost per patient per day in each class was calculated. Using SAS, The number of patients in class and nursing activities in duty for nursing care hours were calculated the percent, the mean, the standard deviation respectively. According to the ANOVA and the $Scheff{\'{e}$ test, direct nursing care hours per patient per day for the each class were analyzed. The results of this study were summarized as follows : 1. Distribution of patient class : class IN(33.5%) was the largest class the rest were class II(26.1%) class III(22.6%), class I(17.8%). Nursing care requirements of the inpatients in hospice ward were greater than that of the inpatients in general ward. 2. Direct nursing care activities : Measurement ${\cdot}$ observation 41.7%, medication 16.6%, exercise ${\cdot}$ safety 12.5%, education ${\cdot}$ communication 7.2% etc. The mean hours of direct nursing care per patient per day per duty were needed ; 69.3 min for day duty, 64.7 min for evening duty, 88.2 min for night duty, 38.7 min for shift duty. The mean hours of direct nursing care of night duty was longer than that of the other duty. Direct nursing care hours per patient per day in each class were needed ; 3.1 hrs for class I, 3.9 hrs for class II, 4.7 hrs for class III, and 5.2 hrs for class IV. The mean hours of direct nursing care per patient per day without the PCS was 4.1 hours. The mean hours of direct nursing care per patient per day in class was increased significantly according to increasing nursing care requirements of the inpatients(F=49.04, p=.0001). The each class was significantly different(p<0.05). The mean hours of direct nursing care of several direct nursing care activities in each class were increased according to increasing nursing care requirements of the inpatients(p<0.05) ; class III and class IV for medication and education ${\cdot}$ communication, class I, class III and class IV for measurement ${\cdot}$ observation, class I, class II and class IV for elimination ${\cdot}$ irrigation, all of class for exercise ${\cdot}$ safety. 3. Indirect nursing care activities and personnel time : Recognization 24.2%, house keeping activity 22.7%, charting 17.2%, personnel time 11.8% etc. The mean hours of indirect nursing care and personnel time per nursing manpower was 4.7 hrs. The mean hours of indirect nursing care and personnel time per duty were 294.8 min for day duty, 212.3 min for evening duty, 387.9 min for night duty, 143.3 min for shift duty. The mean of indirect nursing care hours and personnel time of night duty was longer than that of the other duty. 4. The mean hours of indirect nursing care and personnel time per patient per day was 2.5 hrs. 5. The mean hours of nursing care per patient per day in each class were class I 5.6 hrs, class II 6.4 hrs, class III 7.2 hrs, class IV 7.7 hrs. 6. The elements of the nursing care cost were composed of 2,212 won for direct nursing care cost, 267 won for direct material cost and 307 won for indirect cost. Sum of the elements of the nursing care cost was 2,786 won. 7. The mean cost of the nursing care per patient per day in each class were 15,601.6 won for class I, 17,830.4 won for class II, 20,259.2 won for class III, 21,452.2 won for class IV. As above, using modified hospice patient classification indicators and nursing care activity details, many critical ill patients were hospitalized in the hospice unit and it reflected that the more nursing care requirements of the patients, the more direct nursing care hours. Emotional ${\cdot}$ spiritual care, pain ${\cdot}$ symptom control, terminal care, education ${\cdot}$ communication, narcotics management and delivery, attending funeral ceremony, the major nursing care activities, were also the independent hospice service. But it is not compensated by the present medical insurance system. Exercise ${\cdot}$ safety, elimination ${\cdot}$ irrigation needed more nursing care hours as equal to that of intensive care units. The present nursing management fee in the medical insurance system compensated only a part of nursing car service in hospice unit, which rewarded lower cost that that of nursing care.

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Development of e-learning Education Programs for Social Workers in Hospice and Palliative Care (호스피스완화의료 사회복지사 e-learning 교육과정 개발)

  • Shim, Hye-Young;Chang, Yoon-Jung
    • Journal of Hospice and Palliative Care
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    • v.18 no.1
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    • pp.9-15
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    • 2015
  • Education is essential for specialists in charge terminal care of cancer patients. In the second 10-year plan to conquer cancer under the Cancer Control Act, the Korean government announced a plan to train more hospice and palliative care (HPC) specialists based on quantitative HPC expansion. Specifically, the government aims to develop e-learning programs to foster social workers in HPC, following those offered to doctors and nurses. In HPC, social workers have served a vital role in helping patients overcome psychological and social issues. As professionals, they have carried out their responsibilities and played their part in the field to help HPC to take root and be institutionalized in Korea. To date, it has been difficult to obtain practical knowledge and skills for social workers due to the lack of systematic training program. Development of an e-learning program for social workers, as proposed in this study, should strengthen social workers in charge of terminally-ill cancer patients in terms of their identity, expertise, and practical skills in clinical setting and improve their access to education. We also hope the program to be further developed by the government by introducing an education system that offers refresher courses to guarantee social workers' continued expertise through.

Clinical Practice Guideline for Care in the Last Days of Life

  • Shin, Jinyoung;Chang, Yoon Jung;Park, So-Jung;Choi, Jin Young;Kim, Sun-Hyun;Choi, Youn Seon;Kim, Nam Hee;Yum, Ho-Kee;Nam, Eun Mi;Park, Myung Hee;Moon, Nayeon;Moon, Jee Youn;Kang, Hee-Taik;Kang, Jung Hun;Park, Jae-Min;Lee, Chung-Woo;Kim, Seon-Young;Lee, Eun Jeong;Koh, Su-Jin;Kim, Yonghwan;Cho, Myongjin Agnes;Song, Youhyun;Shim, Jae Yong
    • Journal of Hospice and Palliative Care
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    • v.23 no.3
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    • pp.103-113
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    • 2020
  • A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients' physical and mental symptoms, psychological support, appropriate decision-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.

Nurses' Perception on Fluid Therapy for Terminally Ill Patients (말기 환자의 수액요법에 대한 간호사의 인식)

  • Jo, Hyeon-Sook;Cho, Ok-Hee;Yoo, Yang-Sook
    • Journal of Hospice and Palliative Care
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    • v.13 no.4
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    • pp.243-251
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    • 2010
  • Purpose: This study was conducted to investigate how nurses who take care of terminal patients perceive fluid therapy and how this therapy is currently being used in hospitals. Methods: This survey included 200 nurses, 87 of whom were working in the oncology units of 3 university hospitals in Seoul, Korea, and 113 were working in 18 hospice centers. The data for this study were collected by means of structured questionnaires and analyzed by using the Statistical Analysis System software. The differences in perception towards fluid therapy between nurses working in oncology units and those working in hospice centers were examined using the $x^2$ test and analysis of covariance. Results: Fluid therapy was perceived more negatively by the nurses from hospice centers than by those from oncology units. Continuous subcutaneous infusion was used in hospice centers, but not in oncology units. In addition, the average amount of fluid infused daily differed significantly between the oncology units and hospice centers. Conclusion: Our results show that there were differences in the perception towards fluid therapy between nurses in different clinical settings. Nurses caring for terminal and palliative care patients should not simply provide or withhold fluid therapy, but rather develop a wider range of views on fluid therapy, focusing on effective alternative interventions.

Development of Hospice Oriented Medical Record (HOMR) for Cancer Patients (호스피스 암 환자를 위한 의무기록지의 개발)

  • Seng, Jeong-Won;Hong, Sung-Moon;Kim, Si-Wan;Kim, Jeong-A;Park, Joon-Chul;Kim, Su-Hyun;Seo, Min-Jeong;Her, Sin-Hoe;Kim, Hye-Won;Hong, Myung-Ho;Choi, Youn-Seon
    • Journal of Hospice and Palliative Care
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    • v.7 no.1
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    • pp.49-63
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    • 2004
  • Purpose: The Hospice Oriented Medical Record (HOMR) was developed for assessing the pain and symptoms of terminal cancer patients. Methods and Results: The HOMR consists of an instruction for users and 2 assessment pages which include the graph showing vital signs (temperature, blood pressure, pulse, respiration rate and pain score), current problem lists, performance status, laboratory data, pain characteristics and management, sedation score, associated symptoms and drug side effects, etc. Pilot study was performed in the inpatient Hospice Care Unit in Guro Hospital, Korea University Medical Center. Because an one-week progress data was recorded in HOMR as a flow sheet, the patient's condition and pain control status could be seen at a glance. Conclusion: The HOMR is useful for assessing the terminal cancer patients because it is simple and convenient to use. Further research is needed before it can be universally used in the clinical settings.

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Hospice-Palliative Care Activities of personnel in a Long-Term Care Hospital; a retrospective chart review (일개요양병원 호스피스·완화의료의 서비스의 직종별 행위 분석; 후향적 의무기록 중심으로)

  • Cho, Hyun;Lim, Heeyoung
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.4
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    • pp.570-577
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    • 2017
  • The purpose of this study was to provide a basis for the development of a health insurance payment system by exploring inpatient hospice & palliative care activities in a long-term care hospital by occupational personnel. The contents and frequency of inpatient hospice-palliative care activities were obtained retrospectively from the chart review of 12 terminally ill patients who died during the 6 months before their deaths. According to their occupational personnel, doctors were doing blood transfusion, family counseling, and medication guidance. Nurses' main activities were airway suction, oxygen supply, EKG monitoring, observing patient's status, helping medication and tube feeding. Other workers' activities are as follows: social workers were applying individualized programs, physical therapists were doing electrostimulation, nutritionists were giving nutrition evaluation and meal rounding, and careworkers were assisting with meals and nutrition. Although certain nursing activities, like emotional support, were performed by nurses, the hospice-palliative activities from doctors, social workers and physical therapists were largely unavailable for terminally ill patients in a long-term care hospital. And some terminally ill patients were receiving too intensive and invasive medical cares for end end-of-life care. The results highlight the importance of valid measures of hospice-palliative care quality and the need for establishing an adequate reimbursement system for ensuring and improving end-of-life care.

Operating Report of a Hospice Cyber Counselling Program (호스피스 사이버상담 프로그램 운영에 대한 소고)

  • Yoo, Ji-Soo;Lee, Yoon-Jeoung;Kang, Se-Won
    • Journal of Hospice and Palliative Care
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    • v.9 no.1
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    • pp.30-34
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    • 2006
  • Purpose: This study is to report the operating result of the Hospice Cyber Counselling Program for improving quality of lift for terminal patients and their families. Methods: This study was performed followed by counsellor training, building strategy of public relations, management, and evaluation of the effect in order. Results: 72 subjects visited our cyber homepage and became members for approximately 9 months from Oct. 2004 to July 2005; 17 subjects in their 20s (23.6%), 12 subjects in their 30s (16.7%), 17 subjects in their 40s (23.6%), and 13 subjects above 50s (18%). Classified by diagnose related group, cancer related disease consist of 90%. As for the relationship between contents of counselling and counselling applicants, families consist of 90% and self-applicants only 10%. Only 30 members used on-line counselling and their counselling frequency was just 35 times. Although counselling frequency and the number of members who used the counselling site were not high, they tend to contact with a counsellor continuously and use the site actively after the first counselling. Conclusion: Cyber counselling program for hospice was practically managed to improve quality of life for terminal patients and their families as a basic activity for hospice business activation. Basic public relations with regard to hospice business by mass media and the press should be performed continuously and the hospice training program is required for medical personnel to be continue.

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A Qualitative Study of Physicians' Perspectives on Non-Cancer Hospice-Palliative Care in Korea: Focus on AIDS, COPD and Liver Cirrhosis (국내의 비암성 질환의 호스피스 완화의료 적용에 대한 전문가의 인식에 관한 질적 연구: 후천성 면역결핍 증후군, 만성 폐쇄성 폐질환, 간경화를 중심으로)

  • Shin, Jinyoung;Yoon, Seok-Joon;Kim, Sun-Hyun;Lee, Eon Sook;Koh, Su-Jin;Park, Jeanno
    • Journal of Hospice and Palliative Care
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    • v.20 no.3
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    • pp.177-187
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    • 2017
  • Purpose: From August 2017, hospice-palliative care (HPC) will be provided to patients with acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), and liver cirrhosis in Korea. To contribute to building a non-cancer (NC) hospice-palliative care model, NC specialists were interviewed regarding the goals, details, and provision methods of the model. Methods: Four physicians specializing in HPC of cancer patients formulated a semi-structured interview with questions extracted from literature review of 85 articles on NC HPC. Eleven NC disease specialists were interviewed, and their answers were analyzed according to the qualitative content analysis process. Results: The interviewees said as follows: It is difficult to define end-stage NC patients. HPC for cancer patients and that for NC patients share similar goals and content. However, emphasis should be placed on alleviating other physical symptoms and emotional care rather than pain control. Timing of the care provision should be when patients are diagnosed as "end stage". Special issues should be considered for each NC disease (e.g., use of anti-retroviral drugs for AIDS patients, oxygen supply for COPD patients suffering from dyspnea, liver transplantation for patients with liver cirrhosis) and education should be provided to healthcare professionals. NC patients tend to negatively perceive HPC, and the government's financial assistance is insufficient. Conclusion: It is necessary to define end-stage NC patients through in-depth discussion to minimize issues that will likely accompany the expansion of care recipients. This requires cooperation between medical staff caring for NC patients and HPC givers for cancer patients.

Problems Related to the Act on Decisions on Life-Sustaining Treatment and Directions for Improvement

  • Heo, Dae Seog;Yoo, Shin Hye;Keam, Bhumsuk;Yoo, Sang Ho;Koh, Younsuck
    • Journal of Hospice and Palliative Care
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    • v.25 no.1
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    • pp.1-11
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    • 2022
  • The Act on Decisions on Life-Sustaining Treatment has been in effect since 2018 for end-of-life patients. However, only 20~25% of deaths of terminally ill patients comply with the law, while the remaining 75~80% do not. There is significant confusion in how the law distinguishes between those in the terminal stage and those in the dying process. These 2 stages can be hard to distinguish, and they should be understood as a single unified "terminal stage." The number of medical institutions eligible for life-sustaining treatment decisions should be legally expanded to properly reflect patients' wishes. To prevent unnecessary suffering resulting from futile life-sustaining treatment, life-sustaining treatment decisions for terminal patients without the needed familial relationships should be permitted and made by hospital ethics committees. Adult patients should be permitted to assign a legal representative appointed in advance to represent them. Medical records can be substituted for a patient's judgment letter (No. 9) and an implementation letter (No. 13) for the decision to suspend life-sustaining treatment. Forms 1, 10, 11, and 12 should be combined into a single form. The purpose of the Life-sustaining Medical Decisions Act is to respect patients' right to self-determination and protect their best interests. Issues related to the act that have emerged in the 3 years since its implementation must be analyzed, and a plan should be devised to improve upon its shortcomings.