• Asian Oncology Nursing
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• v.4 no.2
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• pp.143-153
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• 2004

Death of spouse is the most heartbreaking stressful and inevitable tragic life event. In middle aged men who belong to the social middle class and accomplished their occupational success, experiences of spousal bereavement are great shock. The aim of this study was to find out how they overcome their mental and physical pain and to obtain the basic materials to develop suitable nursing care programs for them. The methodological approach of this study is Giorgi's phenomenological analysis meaning unit. This method also makes theme focal meaning, situated structural description and create general structural description grasped by participator's experience through situated structure description. This study performed from November 2002 to May 2004, and participators were four men. Data collected through in-depth personal interviews. which had been tapped and analysed the Giorgi's method. Finally, the five focal meaning below have been abstracted. Theme 1. Physical symptom loss of appetite, fatigue, insomnia. outbreak of illness, weight loss. Theme 2. life of spiritless lack of desire, sense of emptiness, unstableness, prosaic life. wandering. indifference of appearances, avoidance of meeting people. Theme 3. life of retrospction reflection for his wife, yearning, grief, muttering to himself, never-to-be forgotten wife, leading a lonely life. Theme 4. negative emotion reproaching, feeling hurt, marriage of daughter, feeling heavy, getting angry, sexual desire, awareness of his sinfulness. loneliness Theme 5. social support and adjustment getting his wife off his mind, curring favor with children, support and consolation by his daughter-in-law, appreciation for hospice nurse, considering remarriage, taking care of himself, good relation with his children. The result of this study showed that middle aged men bereaved of their wife by cancer need other's concern. And we have to study further to understand their experience. Until now hospice nursing is concentrated on cancer patients But from now we have to provide their families suitable nursing care programs to adjust themselves to social life before and after death of patients.

• Journal of Hospice and Palliative Care
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• v.12 no.2
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• pp.88-94
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• 2009

Chest pain is a symptom observed commonly in outpatients and emergency room patients, and its causes are variable. Because treatment and prognosis of chest pain are different depending on its cause, it is more important than anything else to accurately diagnose the cause of chest pain. Most of patients complaining of chest pain undergo basic tests at a private local clinic or at the Internal medicine or chest surgery department of a general hospital and, they are referred to the pain clinic, with a note stating no particular finding. However, if they have sustained severe neuropathic pain in spite of nerve block, accurate diagnosis for chest pain is essential. We experienced rapidly developing spine breakdown and cord compression caused by metastatic spinal tumor in an inpatient who was being treated for chest pain, and thus, we report here in the case with literature review.

• Journal of Hospice and Palliative Care
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• v.25 no.3
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• pp.110-120
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• 2022

Purpose: The purpose of this study was to confirm the factor structure of the McGill Quality of Life Questionnaire-Revised (MQOL-R) in the context of Korean culture and to verify its reliability and validity. Methods: The participants comprised terminal cancer patients aged 25 or older, and data from 164 participants were analyzed. The study was conducted in the following order: translation, expert review, reverse translation, preliminary investigation and interviews, and completion of the final version. Confirmatory factor analysis was applied to evaluate the validity of the instrument, and the Beck Depression Inventory, Korean version (K-BDI) was applied to confirm the criterion validity of the MQOL-R Korean version. The Cronbach's alpha coefficient, representing internal consistency, was measured to evaluate reliability. Results: Cronbach's alpha for all 14 questions was 0.862. The model fit indices for confirmatory factor analysis were within the acceptance criteria. The factor loadings of all four factors were over 0.50, and convergent validity and discriminant validity were confirmed. Regarding criterion validity, a negative correlation was found between the four factors of MQOL-R Korean version and the K-BDI. Conclusion: The MQOL-R Korean version, the reliability and validity of which were verified in this study, is a 15-item tool consisting of 14 items dealing with four physical, psychological, existential, and social factors and a single item evaluating the overall quality of life. The MQOL-R Korean version is an instrument that can more concisely and effectively measure the quality of life of patients with life-threatening diseases.

• Journal of Hospice and Palliative Care
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• v.26 no.2
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• pp.42-50
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• 2023

Purpose: The purpose of this study was to identify barriers to effective conversations about advance care planning (ACP) and palliative care reported by health care and community-based service providers in Massachusetts, USA. Methods: This qualitative research analyzed open-ended responses to two survey questions, inquiring about perceived barriers to having conversations about ACP and palliative care with patients and consumers. Data were collected between November 2017 and June 2019 from nine organizations in Massachusetts, including health care provider organizations, health insurers, community-based organizations, and a nursing education institution. Two researchers reviewed and coded the responses and identified common themes inductively. Results: Across 142 responses, primary barriers to ACP included hesitation and lack of understanding and knowledge, discomfort and resistance among service providers, lack of staff knowledge, difficulties with followup, and differences in ACP policies across regions. Common barriers to palliative care were misconceptions about palliative care and lack of knowledge, service providers' lack of preparedness, and limited policy support and availability. Challenges relevant to both ACP and palliative care were fear and discomfort around serious illness discussions, lack of knowledge and awareness, discussions that occur too late, and cultural and language barriers. Conclusion: Health care practitioners and community-based professionals reported consumer-, service provider-, and system-level barriers to facilitating conversations about ACP and palliative care with patients experiencing serious illness. There is a need for more tools and support to strengthen service providers' ACP and palliative care competencies and to promote a structured approach to health care planning conversations.

• Journal of Hospice and Palliative Care
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• v.25 no.2
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• pp.55-65
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• 2022

Caring for patients with cancer is highly stimulating and rewarding, attracting health professionals to the field who enjoy the challenge of managing a complex illness. Health professionals often form close bonds with their patients as they confront ongoing disease or treatment impacts, which may be associated with multiple losses involving function and/or eventual loss of life. Ongoing exposure to patient loss, along with a challenging work setting, may pose significant stress and impact health professionals' well-being. The prevalence rates of burnout and compassion fatigue (CF) are significant, yet health professionals have little knowledge on these topics. A 6-week continuing education program consisting of weekly small-group video-conferencing sessions, case-based learning, and an online community of practice was delivered to health care providers providing oncology care. Program content included personal, organization and team-related risk and protective factors associated with CF, grief models, and strategies to mitigate against CF. Content analysis was completed as part of the program evaluation. In total, 189 participants (93% nurses) completed the program, which was associated with significant improvements in confidence and knowledge of CF and strategies to support self and team resilience. Qualitative themes and vignettes from experiences with the program are presented. Key themes included knowledge gaps, a lack of support related to CF and strategies to support resilience, organization-and team-based factors that can inhibit expression about the impacts of clinical work, the health professional as a "person" in caregiving, and the role of personal variables, self-skill practices, and recommendations for education and support for self and teams.

• The Korean Journal of Pain
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• v.37 no.2
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• pp.119-131
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• 2024

There are growing concerns regarding the safety of long-term treatment with opioids of patients with chronic non-cancer pain. In 2017, the Korean Pain Society (KPS) developed guidelines for opioid prescriptions for chronic non-cancer pain to guide physicians to prescribe opioids effectively and safely. Since then, investigations have provided updated data regarding opioid therapy for chronic non-cancer pain and have focused on initial dosing schedules, reassessment follow-ups, recommended dosage thresholds considering the risk-benefit ratio, dose-reducing schedules for tapering and discontinuation, adverse effects, and inadvertent problems resulting from inappropriate application of the previous guidelines. Herein, we have updated the previous KPS guidelines based on a comprehensive literature review and consensus development following discussions among experts affiliated with the Committee on Hospice and Palliative Care in the KPS. These guidelines may assist physicians in prescribing opioids for chronic non-cancer pain in adult outpatient settings, but should not to be regarded as an inflexible standard. Clinical judgements by the attending physician and patient-centered decisions should always be prioritized.

• Journal of Hospice and Palliative Care
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• v.11 no.4
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• pp.181-187
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• 2008

Purpose: In order to establish efficient palliative treatment plans. It is important to estimate the survival time of a terminally ill cancer patient as accurate as possible. Proper estimation of life expectancy aids not only in improving the quality of life of the patient, it also promotes productive communication between the medical staff and the patient. The aim of this study is to determine the efficacy of neutrophil-lymphocyte ratio as a predictor of survival time in terminally ill cancer patients. Methods: Between January 2004 and June 2007, 67 terminally ill cancer patients who were admitted or transferred for palliative care, were included. Patients were categorized into three groups by Neutrophil-Lymphocyte Ratio. Demographic characteristics, clinical characteristics and blood samples were analyzed. Results: In univariate analysis, survival time of the highest Neutrophil-Lymphocyte Ratio group (${\geq}12.5$) was significantly shorter than that of the others (hazard ratio (HR)=3.270, P=0.001). After adjustment for low performance status (ECOG score 4) and dyspnea, high Neutrophil-Lymphocyte Ratio (${\geq}12.5$) was significantly and independently associated with short survival time (HR=2.907, P=0.007). Neutrophil-Lymphocyte Ratio was also significantly increased before death (P=0.001). Conclusion: Neutrophil-Lymphocyte Ratio can be useful in predicting life expectancy in terminally ill cancer patients.

• Korean Journal of Hospice Care
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• v.3 no.2
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• pp.19-33
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• 2003

Cancer causes many crises to cancer patients imcluding physical dysfunction and emotional changes such as anxiety, depression as well as a threat of life, fear of death. As it develops, cancer makes people feel powerlessness due to the losses of their own positions, roles and independence. Although occupying a little proportion among all types of cancer, head and neck cancer may cause a wide range of physical transformation by surgical operation, damage to active functions such as eating and speaking, provoke anxiety and depression after its operation, influencing the quality life of head and neck cancer patients. Thus nursing intervention should be developed to provide supportive nursing for head and neck cancer patients and play roles as competent supporters. This study is a nonequivalent, control group, pretest-posttest, non-synchronized quasi-experimental research design to determine, how nursing intervention has effects on anxiety, depressing of head and neck cancer and operated. They were divided into experimental and comparison groups, each consisting of 20 members. The data were collected during the period from December 1, 1999 to April 11, 2000. Tools of the study included the protocol of supportive nursing intervention which was developed by researcher with reference to a literal review and esperts' advice. The measurement tool of anxiety was consisting of totaled 20 question items which was prepared by Spielberger and translated by Kim et al., the device of depression measurement consisting of total 20 question items which was the output of Song's translation the device of depression self-evaluation from Zung. Data were analyzed using the SPSS/PC 9.0 program. The homogeneity of the subjects were tested using x2-test and t-test. 5 hypoteses were tested using t-test. The results of the study can be summarized as follows. 1.The first hypothesis that the experimental group receiving supportive nursing intervention shows a little anxiety than the control group not receiving supportive nursing intervention was supported(t=3.817, P=.000). 2.The second hypothesis that the experimental group receiving supportive nursing intervention shows a little depression than the control group not receiving supportive nursing intervention was supported(t=8.089, P=.000). Consequently, supportive nursing intervention was found an effective nursing intervention strategy to reduce anxiety and depression of head and neck cancer patients. Providing supportive nursing intervention in nursing practice can enhance the quality of life of those cancer patients.

• Journal of Hospice and Palliative Care
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• v.10 no.1
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• pp.43-47
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• 2007

Decision-making of antibiotics use in infected patients with terminal stage of cancer was difficult for physicians, because of responsibility of solving a medical problem and burden on patients distressed by worthless life expansion. Korean Family Medicine Palliative Medicine Research Group discussed this subject using a case of a 65 year-old male having terminal stage of sigmoid colon cancer with extended cutaneous infection who was treated local antibiotics, improved but expired at the 12th hospital day. We reviewed related literatures and proposed a guide for antibiotics use in inferred patients with terminal stage of cancer. Antibiotics should be used for symptom control as major indication, especially when patients suffered from urinary symptoms. Appropriate antibiotics should be chosen based or sensitivity test. the most important considering factor should be patient and family members' wish about antibiotics use.

• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.216-222
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• 2013

Purpose: The purpose of this study was to examine nurses' emotional responses and ethical attitudes towards elderly patients' Do-Not-Resuscitate (DNR) decision. Methods: Data were collected using a questionnaire which was filled out by 153 nurses who worked in nursing homes and general hospitals. Data were analyzed using real numbers, percentages, means, standard deviations and Pearson's correlation coefficients with SPSS 19.0 program. Results: The average score for ethical attitudes towards the DNR decision was 2.68 out of 4. Under the ethical attitudes category, the highest score was found with a statement that said 'Although they will not perform cardiopulmonary resuscitate (CPR), it is right to do their best with other treatments for DNR Patients'. Items regarding emotional responses to the DNR decision, the average score was 2.36 out of 4. Among them, the highest score was achieved on 'I understand and sympathize'. No significant correlation was found between ethical attitudes and emotional responses in relation to patients' DNR decision (r=-0.12, P=0.13). Conclusion: Regarding elderly patients' DNR decision, nurses showed somewhat highly ethical attitudes and slightly positive emotional response. A follow-up study is needed to investigate variables that affect our results.