• Journal of Korean Biological Nursing Science
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• 제7권1호
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• pp.57-68
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• 2005

Purpose : The purpose of this study was to develop a tool to assess the need for hospice care in families of patients with cancer. Method : Research design was a methodological study. The tool was developed in 3 stages : first, preliminary items were developed based on a questionnaire about the needs for hospice care that was given to 8 families of patients with cancer; second, a panel of specialists reduced the number of preliminary items using 2 validity tests on the contents. Finally, reliability and validity were tested by a sample of 98 families who have a patient with cancer from April 2003 to July 2004. Result: Cronbach's alpha coefficient for internal consistency was .94 for the final total 22 items. Using the factor analysis, 4 factors with eigenvalue of more than 1.0 were extracted and these factors explained 65% of the total variance. The four factors were labeled as 'control of terminal physical problems', 'emotional care', 'spiritual care for preparing for death', and 'family support'. The final items of the tool developed on the need of hospice care consisted of 22 items. Conclusion : The instrument, for accessing the need for hospice care in families of patients with cancer, developed in this study was identified as a tool with a high degree of reliability and validity. In this sense, this tool can be effectively utilized for implementing and improving hospice care for patients with terminal cancer.

• 대한간호학회지
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• 제30권4호
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• pp.1045-1054
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• 2000

As cost pressures have escalated, policy makers, politicians, health care providers and families have tried to devise ways to reduce health care costs. While originally developed to enhance patient control and to provide better care at the end of life, hospice care has recently received significant attention as a mean of reducing health care costs. As a program providing care for patients who are dying at their homes, hospice has expanded slowly since the opening of the first hospice in Korea in 1963. Therefore, a variety of services that responds to the needs and concerns of many dying people and their families is limited The purpose of this study was to determine the potential cost savings at the end of life among patients who used home hospice compared with the patients who received institutional care in Korea. This study used a retrospective, descriptive design. The sample for this study included 46 patients who died of lung cancer: 25 patients who received home hospice care and 21 patients who received institutional care. Data on patient characteristics, kinds and frequencies of provided treatment and nursing services, and hospice and hospital charges during the last month before death were collected. Cost of care was measured by the average cost per patient per day in the last month of life. The results of the study indicated that there were significant differences in average cost of care between home hospice sample and institutional care sample (t=9.956, p<.001; home hospice sample: M=18,102 won, institutional care sample: M=317,578 won). The cost of the home hospice sample was approximately 6% of the cost of institutional care. The majority of the home hospice nursing services were education (35.7%) and supportive counseling (25.2%), followed by medication management (13.6%), assessment (12.1%), basic nursing (7.2%), treatment (5.5%) and others. In institutional care sample, basic nursing and treatment were more emphasized than education or supportive counseling among the nursing services provided. The results of this study showed the potential for hospice to reduce costs and implications for policymakers and clinicians to incorporate hospice program into the formal health care delivery system in Korea.

• 기본간호학회지
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• 제7권2호
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• pp.287-300
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• 2000

The purpose of this study was to identify nursing needs for hospice patients and their families in order to establish a foundation for appropriate Korean hospice care. To achieve the purpose of this study, 1 interviewed 50 patients who were going to die within 3 or 6 months and 42 family members of these patients who were registered in Pusan National University Hospital Hospice Program. The interview was done in the patient's room using semi-dialog style questionnaire. Data collection was done from March 1, 1999 to September 30. 1999. The important results of this study are summarized as follows : 1. Nursing needs that patients and their families have experienced were classified into six nursing domains; physical, emotional, economic, educational, spiritual and postmortal care. 2. Nursing needs of hospice patients are; pain control(80%), physical comfort(72%), consideration from medical personnel(68%), provision of information(64%), best treatment(60%), help of volunteers(36%), and continuous hospital treatment(32%). 3. Nursing needs of the families are; pain-control in Patients(97.6%), best treatment(97.6%), physical comfort of patients(95.2%), continuous hospital treatment(92.8%), provision of information(80.9%), consideration from medical personnel(76.1%), expectation of recovery(66.6%), emotional support of family(61.9%), and physical comfort of family(40.4%). It is concluded that there is a real difference between the nursing needs of patients and the nursing needs of their families. Therefore we must examine and intervene for the demands of patients and their families using a holistic approach in order to meet their hospice needs.

• 지역사회간호학회지
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• 제15권4호
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• pp.639-647
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• 2004

Purpose: The purpose of this study was to analyze the need for hospice care programs in families of patients with cancer. Method: The study surveyed 98 families who were taking care of patients with cancer. This survey was conducted from August 2004 to October 2004 at two general hospitals in Seoul. The data were collected through a self-reporting questionnaire of 22 items. The items were classified into five areas by factor analysis to identify the construct validity. The reliability of the tool was established by Cronbach's alpha as .93 and the data collected were analyzed by descriptive statistics, t-test and ANOVA. Results: 1) The degree of need for hospice care of the subjects showed a high average of $3.26({\pm}3.7$). The need for 'emotional care of patients showed the highest mean' (M=3.47), 'management of terminal physical symptoms' (M=3.34), 'control of secondary physical problems' (M =3.26), 'acceptance of the family's difficulty' (M=3.12), 'spiritual care for preparing for death' (M=2.96), respectively. 2) With respect to the demographic characteristics of the subjects, there were statistically significant differences in hospice care needs, according to the onset of diagnosis (F=3.110, p=.030). Conclusion: Hospice care must be provided considering the needs of families of patients with cancer. In this sense, this country's needs as well as hospice nurses' higher concern and support for hospice care of patients require further education and program development to meet the current demands.

• 보건행정학회지
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• 제10권3호
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• pp.68-87
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• 2000

This study aims at the operation of the hospice in the virtual space by the use of telecommunication technology. The hospice can be an efficient alternative for the elderly and terminal patients. It can achieve both the quality of life of patients and the conservations of medical resources. The virtualization creates new norms and values which are different from the conventional environments. The concepts and limitations which are crucial to the projection of the existing hospice into the virtual space are discussed. The items ranging from the hospice need to the design criteria of the modules are investigated. The most important point in constructing the virtual hospice center is the human factor, which characterizes the hospice. In addition, the real-world circumstances of the hospice should be considered in the realization of the VHC.

• Journal of Hospice and Palliative Care
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• 제22권1호
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• pp.1-7
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• 2019

한국에서 호스피스의 기원은 11세기 초, 고려시대의 동서대비원(東西大悲院)에서 그 유래를 찾을 수 있다. 한국에 호스피스가 도입된 이후, 50여년이 흘렀고, 초기에는 종교적 배경과 민간차원의 활동이 더디게 발전해왔으나, 1990년대에 각 종교단체가 구성되고 학회가 출범한 이후, 2000년대 초기부터 정부의 개입으로 제도화가 진행되면서 본격적인 성장기를 맞게 되었다. 비록 말기암환자와 그 가족들의 고통이 경감되고 삶의 질과 서비스의 질은 향상되었으나, 안정적인 재정기반을 보장할 수 있는 현실적인 보상체계는 마련되지 못했었다. 그러나, 2015년에 호스피스 완화의료 서비스에 대한 국민건강보험 급여수가가 인정되었고, 2016년에 "호스피스 완화의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법률"이 제정되어 말기환자의 무의미한 연명치료를 거부할 수 있게 되었으며, 호스피스 완화의료 서비스의 대상 질환이 확대되면서 서비스제공자들에게는 더 많은 도전과 과제들이 남아있다.

• Journal of Hospice and Palliative Care
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• 제7권2호
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• pp.232-237
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• 2004

배경: 보편적으로 호스피스 병동에서 말기 암 환자에 있어서, DNR 동의가 흔하게 취득되고 있다. 그러나 말기 암 환자에 대한 현황과 실태 분석에 관한 국내 연구는 아직 드문 현실이다. 최근 저자 등은 보호자가 DNR 동의를 거부하여 심폐소생술 후 인공호흡기 치료를 시행하여 2개월 간 중환자실에서 치료 후 사망한 환자를 경험하면서 지금 까지 진행된 DNR 동의의 현 실태와 앞으로 시행될 DNR 동의의 보완점을 마련하기 위해 본 연구를 시작하였다. 방법: 2003년 1월부터 6월까지 6개월 동안 성빈센트병원 호스피스 병동에 입원한 말기 암 환자 60명을 대상으로 후향적으로 의무기록과 DNR 동의서를 조사하였다. 대상 환자들의 나이, 성별,진단명, DNR 동의 시간, 사망까지의 시간, DNR 동의에 참여한 보호자, DNR 결정 당시 환자 상태, 사망장소, DNR 결정 당시의 치료와 DNR 결정 전후 치료의 변화 등을 조사하였다. 치료 단계는 3단계로 분류하였다. 결과: 중앙 연령은 66세($31{\sim}93$세) 였고 남자가 31명, 여자가 29명이었다. 폐암 12명, 위암 12명, 담낭암 및 담도암 7명, 대장암 6명, 췌장암 4명, 기타 19명이었다. DNR 동의서에 서명한 사람은 아들이 22명, 배우자가 19명, 딸이 16명, 기타가 3명이었다. 이 중 환자가 DNR 동의서에 동의한 경우는 한 명도 없었다. 60명 중 30명이 입원 시에, 30명은 입원 기간 중에 DNR 동의서에 서명하였다. 입원 기간 중에는 증상의 악화 19명, 활력 증후 변화 4명, 다기관 기능부전 3명, 기타 상태 4명 등으로 DNR이 결정 되었다. DNR 동의 후 사망까지의 시간은 13명이 5일 이내에 사망하였다. 사망 장소는 60명 중 한 명을 제외하고는 모두 본원이었다. DNR이 시행되었을 당시 치료 단계는 2명을 제외하고 1단계였고 2단계와 3단계가 각각 1명씩이었다. 결론: 환자의 존엄성과 권리라는 측면에서 DNR 동의의 환자 참여가 국내에서도 신중하게 고려되어야 하겠다. 또 이를 위해 DNR 동의의 의미, 경과, 동의 철회 등의 사항이 포함된 문서화된 동의서에 의해서 환자와 보호자에게 설명되어야 하겠다.

• Journal of Hospice and Palliative Care
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• 제24권1호
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• pp.46-55
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• 2021

Purpose: This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients. Methods: Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospice and palliative care unit. Perceptions, preparedness, and anxiety regarding death were assessed with a self-administered structured questionnaire, and participants' scores before and after counseling were compared using the paired t-test. Results: Significant changes were found in perceptions, preparedness, and anxiety regarding death after counseling. Compared to before counseling, the scores for perceptions of death (t=-4.90, P<0.001) and preparedness for death and dying (t=-16.23, P<0.001) improved, while anxiety (t=3.72, P=0.001) decreased after counseling. Some changes were also found in the types of support that family caregivers needed to prepare for the death of their family members in the hospice care unit. Conclusion: The findings demonstrate that death counseling could help family caregivers prepare for the death of their loved ones. Hospice and palliative care providers should play a key role in supporting family caregivers of hospice patients by developing strategies for counseling.

• Journal of Hospice and Palliative Care
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• 제3권1호
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• pp.4-17
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• 2000

목적 : 본 연구는 우리나라의 호스피스 프로그램 현황을 조사하여 향후 호스피스관련 정책 수립을 위한 참고자료를 제시하고, 궁극적으로 말기환자의 삶의 질을 향상하고 보건의료자원의 효율적 이용을 도모하는 것을 목적으로 수행되었다. 방법 : 전국의 59개 호스피스 프로그램을 대상으로 기관 일반현황과 활동 인력 현황, 환자 현황, 케어 현황, 재정 현황, 시설 현황 등을 우편설문 조사하였다. 조사에 응답한 기관은 38개(64.4%)기관을 분석하였다. 결과 : 조사에 응답한 기관은 3차진료기관이 11개소, 3차 진료기관을 제외한 병원급 이상 의료기관이 11개소, 의원이 3개소, 가정방문팀이 12개소, 독립시설이 1개소였다. 38개 기관을 중심으로 운영현황을 조사한 결과, 호스피스 기관마다 활동 내용 및 구조에서 큰 차이가 있었고, 일부 기관은 호스피스 기관임을 지향함에도 불구하고 엄밀한 의미에서의 호스피스의 요건을 충족시키지 못하고 있었다. 38개 기관중 호스피스 활동의 기본 인력을 모두 갖춘 곳은 9개소에 그쳤고, 호스피스 교육을 받지 않은 자원봉사자가 활동하는 기관도 있었다. 절반 이상의 기관이 '의식이 분명하고 의사소통이 되는 환자만을 대상으로 한다'는 호스피스 케어의 일반 원칙을 준수하지 않고 있었고, 환자의 의무기록을 보관하지 않는 기관도 16%나 되었다. 3차 진료기관을 비롯한 병원의 호스피스에서는 상대적으로 강도 높은 의료서비스가 제공되고 있는 것을 확인할 수 있었다. 호스피스 프로그램이 기관마다 큰 편차를 보이고, 일반적인 호스피스 기준에 미치지 못하는 기관이 많음에도 불구하고 본 조사의 응답기관 중 11개 기관에서 대기중인 호스피스 환자가 있다고 답하여 호스피스에 대한 수요는 제공기관의 공급을 초과하는 것으로 나타났다. 결론 ; 말기환자는 지속적으로 발생하며 말기환자에 의한 의료자원 소모가 점차 중요한 문제로 부각되고 있다. 그러한 고비용의 서비스보다 증상조절을 중심으로 한 호스피스 케어가 말기환자의 삶의 질 향상에 유용하다는 보고가 증가하고 있으므로, 장차 우리나라에서도 말기환자를 위한 호스피스의 제도화가 고려되어야 할 것이다. 호스피스의 제도화를 앞당기기 위해서는 호스피스 프로그램의 표준화와 함께 호스피스 프로그램 신임(Accreditation)제도 도입 등을 적극적으로 검토하여 질적 수준을 높혀 나아가야 할 것이다.

• 호스피스학술지
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• 제6권2호
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• pp.1-9
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• 2006

In this thesis, Chapter I Introduction suggested the necessity of this research and defined related terms, and Chapter II defined hospice for children and examined the symptoms of pediatric cancers as well as the general characteristics of pediatric cancer patients. In particular, we surveyed the physical condition, psychological and emotional condition, financial condition, environmental aspect, educational aspect and spiritual aspect of pediatric cancer patients’ families, investigated pediatric cancer patients’ parents and siblings with regard to their understanding of the pediatric cancer patients’ death, and lastly considered spiritual care. Chapter III presented summaries and conclusions. In their developmental stage, pediatric cancer patients lack abilities to express themselves and are highly dependent on their parents, so parents who take care of cancer children have to make hard decisions and cancer children’s families are heavily burdened by the situation of preparing their children’s death and sending them away while denying their death, and for this reason they need help from specialists. That is, for pediatric cancer patients, we need highly experienced pediatricians or nurses skilful in managing young terminal patients as well as hospice counseling and family counselors for consulting on family crises. In particular, there is a keen need of child life support specialists. In addition, clergymen’s help is critical for spiritual care to ease the fear and terror of the unknown world, fear of death, etc. Moreover, in order to prevent cancer children from failing to adjust themselves to school life or peer relation after recovery, hospice service should provide cancer children with opportunities to learn school curriculums and associate with friends.