• 제목/요약/키워드: terminal care

검색결과 458건 처리시간 0.034초

말기암환자에서 불응성 호흡곤란 완화를 위한 Furosemide 흡입치료 -대한가정의학회 완화의학연구회 세미나에 기초한- (Applying Inhaled Furosemide for Refractory Breathlessness in Terminally-ill Cancer Patients - Based on Seminar of Palliative Medicine Research Group, The Korean Academy of Family Medicine -)

  • 황인철;이민규;김경곤;이경식;서희선;대한가정의학회 완화의학연구회
    • Journal of Hospice and Palliative Care
    • /
    • 제13권4호
    • /
    • pp.252-256
    • /
    • 2010
  • 말기 암환자에서의 호흡곤란은 매우 흔하면서도 고통스러운 증상이다. 불응성 호흡곤란은 호흡곤란을 야기시키는 가역적인 원인들이 배제되고 기존의 고식적인 치료에 반응하지 않는 상태로 정의할 수 있으며, 일반적으로 아편유사제와 벤조디아제핀이 사용된다. 대한 가정의학회 완화의학연구회에서는 호흡곤란의 원인이 다른 2명의 증례에서 사용한 furosemide 흡입치료에 대해 논의하였다. Furosemide 흡입치료는 비교적 최근에 대두된 것으로 아직까지 그 효과나 기전이 불명확하여 임상에서 일률적으로 사용하기에는 무리가 있지만, 뚜렷한 폐쇄성 기도병변이 없는 불응성 호흡곤란 환자에서는 고려해 볼 수 있겠다. 본 증례토론을 통해 국내 완화의료 종사자들과 furosemide 흡입치료 경험을 공유하고, 아울러 향후 이 주제에 대한 연구의 방향을 제시하고자 한다.

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

  • 성정원;홍성문;김시완;김정아;박준철;김수현;서민정;허신회;김혜원;홍명호;최윤선
    • Journal of Hospice and Palliative Care
    • /
    • 제7권1호
    • /
    • pp.49-63
    • /
    • 2004
  • 배경: 호스피스 암 환자에게 적합한 경과기록지의 부재 또한 적절한 암성 통증 관리의 장애요인으로서 기존의 "문제 지향식 의무기록"의 경과기록지 형식에서 벗어나 호스피스 암 환자를 위한 의무기록지(HOMR)를 개발하게 되었다. 방법 및 결과: 2004년 3월부터 5월 사이 고대 구로병원 호스피스 팀은 20여 차례의 모임을 갖고 호스피스 환자의 초기 평가 이후 경과기록에 사용할 수 있는 의무기록지를 개발하였다. 구성항목의 결정은 pilot study를 통해 수정과정을 거쳤다. HOMR은 A4용지 크기로 작성자를 위한 지침서 1장과 2장의 경과기록지로 구성되었다. 앞면에는 환자의 인적 사항, 현재 문제목록 및 활동 수행 능력 상태, 검사 결과, 1주일 간의 활력 징후 및 I/O, 배변 횟수가, 뒷면에는 통증 부위, 통증의 성격 및 강도, 약물 및 비약물 요법, 진정 정도, 동반 증상, 약물 부작용 등을 한꺼번에 기록할 수 있도록 구성되어 있다. 결론: 호스피스 암 환자를 위한 의무기록지는 짧은 여명과 다양한 신체 증상을 갖고 있으며 증상의 변화가 빠르지만 만성적인 경과를 보이는 호스피스 환자에게 적합하며 그 자체만으로도 교육자료로서의 가치가 높고 환자를 돌보는 데 있어 진료의 질을 평가하거나 심사할 수 있으므로 진료의 질을 높이는 역할도 기대된다.

  • PDF

말기암환자의 혈중 Visfatin 농도와 식욕부진의 관계 (The Relationship of Plasma Visfatin Level and Anorexia in Terminal Cancer Patients)

  • 이소진;이준용;최윤선;이준영
    • Journal of Hospice and Palliative Care
    • /
    • 제17권1호
    • /
    • pp.18-26
    • /
    • 2014
  • 목적: 식욕부진은 호스피스 암환자의 흔한 증상이며 여러 문헌에서 먹는 행동(feeding behavior)을 조절하는데 있어 visfatin의 가능성을 제시하고 있다. 본 연구에서는 말기암환자에서 증가한 visfatin 농도가 식욕조절과 영양상태 항상성 조절에 관여할 것이라 가설을 세웠다. 방법: 2009년 7월부터 2010년 7월까지 13개월 동안, 만 20세 이상의 말기암환자 69명을 대상으로 혈장 visfatin 농도를 측정하였다. 나이, 성별, 체질량 지수, 활력 징후, 원발암 부위, 암 치료 경력, 투약상황, ECOG(Eastern Cooperative Oncology Group) 수행지수, 혈색소, 백혈구 수, C-반응성 단백질, 총 콜레스테롤, 알부민, 림프구수, 혈당, 혈액요소질소, 크레아티닌, TNF-${\alpha}$ (tumor necrosis factor-alpha), Interukin-6, 렙틴 등의 혈액검사를 시행하였다. 결과: 대상자의 평균 나이는 65.5세였고 단변량 분석상 맥박, ECOG 수행 지수, opioid 사용여부, visfatin 농도에 따라 식욕부진이 있는 군과 없는 군의 차이를 보였다. Visfatin 농도는 단변량 분석결과 식욕부진과 관련이 있는 것으로 나타났으나(P=0.0323) 식욕부진에 영향을 주는 인자들을 보정한 다중 로지스틱 회귀 분석 결과에서는 통계학적인 관련성이 사라졌다. 영양지표들 중 체질량 지수, 렙틴, 총 콜레스테롤과는 관련이 없었으나 림프구수(P=0.0198) 혈중 albumin 농도(P=0.0013)와 중간 정도의 음의 관련성을 나타냈다. 결론: 호스피스 암환자에서 visfatin과 식욕부진의 관련성은 통계적으로 유의하지 않았다. 향후 기전에 대한 연구와 전향적 연구가 필요할 것으로 생각된다.

고용량과 저용량의 몰핀을 쓰는 말기 암 환자에서 임종 1주일동안 비교 (The Comparison between High Dose and Low Dose Morphine in Terminal Cancer Patients During the Last 1 Week to Death)

  • 조두연;차규진;윤방부;염창환
    • Journal of Hospice and Palliative Care
    • /
    • 제5권1호
    • /
    • pp.24-30
    • /
    • 2002
  • 배경 : 통증은 암 환자에서 가장 두려운 증상중의 하나이다. 암 환자의 $65{\sim}85%$가 통증을 경험하였고, 이들 환자에게 때에 따라서는 고용량의 몰핀이 사용되기도 한다. 그러나 많은 의사들은 아직까지 몰핀에 대한 두려움을 가지고 있어, 고용량의 몰핀을 쓰는 데 주저하고 있다. 이에 저자 등은 말기 암 환자에서 몰핀 사용에 대한 실태조사를 통해 몰핀 용량에 따른 차이가 있는지 여부를 알아보고자 하였다. 방법 : 2000년 7월 1일부터 2001년 12월 31일까지 경기도 고양시 소재 일개 종합병원 가정의학과에 입원하여 1주일 이상 생존하였다가 임종한 암 환자 99명을 대상으로 환자의 인구통계학적인 자료 임상 병리 검사, 몰핀 사용 용량 등을 조차하였다. 몰핀은 사용 용량에 따라 OME(oral morphine equivalent)로 계산하여 150 mg이하면 저용량으로 150 mg 초과면 고용량 군으로 나누어, 나이, 성별, 암의 종류, 전이 여부, 몰핀의 부작용 등의 측면에서 두 군간의 차이가 있는 지를 ch-square test를 통해 분석하였다. 결과 : 평균 연령에서는 저용량군이 $65.0{\pm}13.1$세, 고용량군이 $59.9{\pm}11.6$세였고, 성별은 저용량군이 남자 32명(50.0%), 여자 32명(50.0%), 고용량군은 남자 15명(51.7%), 여자 14명(48.3%)이었다. 암의 종류를 보면 두 군 다 위암이 제일 많았고, 그 다음으로 폐암 순이었다. 전이 여부에서는 저용량군 중 58명(90.6%), 고용량군 중 28명(96.6%)에서 전이가 있었다. 기타 완화적 목적의 방사선 치료나 부작용 측면에서 두 군간의 차이는 없었다. 결론 : 암 환자에서 임종 1주일 동안 몰핀 용량에 따른 차이는 없었다. 그러므로 말기 암환자를 치료하는데 있어 고용량 몰핀 사용을 주저할 필요는 없다.

  • PDF

간호사의 안락사와 임종 간호에 대한 의미분석 (The Study of Meaning in Euthanasia and Hospiece Nursing among Nurses)

  • 김애경;박계선
    • 기본간호학회지
    • /
    • 제7권3호
    • /
    • pp.379-390
    • /
    • 2000
  • Euthanasia have received considerable attention recentely in medical literature, public discussion, and proposed state legislation. Almost all the discussion in this area has focused on the role of physicians. However, nurse may be in special position to understand the wishes of patients and to act on this understanding. Purpose of this study is to identity the meaning of euthanasia in terminal ill patients on the nurses' veiw. Forcused interveiw design was used to data collection The data were analyzed by semantic analysis, and analysis of the data resulted in identification of 14 categories representing the meaning of euthanasia. 1. The meaning of supported euthanasia is 'free of suffering', 'difficulty of economic status', 'right of patient and family', 'dignity of death', 'organ transplant', 'social legislation'. 2. The meaning of opposited euthanasia is 'artificial death', 'value of life', 'uncertainity', 'guilt feeling' 3. The meaning of care in terminalily ill patients is 'avoidance', 'powerlessness'. 'apathy'. 'passive attitude'. The policy debate about professional roles in action that end of lives of patients must be extended nurses. Nurses must take an active role in discussion and definition of acceptable practice at the end of life.

  • PDF

임종환자를 돌보는 병원간호사의 경험: 감정에 충실하면서 자신 추스르기 (Nurses Experience of Caring for Dying Patients in Hospitals)

  • 이명선
    • 대한간호학회지
    • /
    • 제33권5호
    • /
    • pp.553-561
    • /
    • 2003
  • Purpose: To develop a substantive theory that represents hospital nurses' experience on caring for dying patients. Method: Grounded theory method guided the data collection and analysis. A purposeful sample of 15 hospital nurses participated during the period of 2001-2002. The data were collected by semi-structured individual interviews. All interviews were audio taped and transcribed verbatim. Constant comparative analysis was employed to analyze the data. Result: 'Putting oneself into shape while being faithful to feelings and emotions' emerged as the basic social-psychological process. Three different phases were identified: being faithful to own feelings and behaviors; putting oneself into shape; and mourning death. The first phase includes the categories of 'establishing trust relationships' and 'sympathizing with dying patients and their family members.' The second phase consists of 'controlling feelings,' 'adjusting ethical conflicts,' and 'providing best patient-care,' and 'helping family accept the jeath.' And the third phase consists of 'overcoming sadness' and 'releasing other negative feelings.' Conclusion: The result of this study will help health professionals develop efficient support programs that support nurses caring for dying patients in hospitals. Further study needs to be done to verify findings.

호스피스 환자와 비호스피스 환자의 영적 안녕과 삶의 질 (Comparison of Spiritual Well-being and Quality of Life between Hospice Patients and Nonhospice Patients)

  • 이해숙;도복늠
    • 성인간호학회지
    • /
    • 제15권3호
    • /
    • pp.364-372
    • /
    • 2003
  • Purpose: This study was conducted to find out the effects of hospice care by evaluating the spiritual well-being and quality of life in the hospice and nonhospice patients. Method: The research design was composed of descriptive study. The data were collected using the questionnaire with interview from 30 hospice patients at three hospice institutes and 30 nonhospice patients at two general hospitals. The tools used for this study were 14-item questionnaire regarding general characteristics, a revised Spiritual Well-being Survey(Paloutzion and Ellision, 1982) and 22-item of revised Mcgill Quality of Life questionnaire. Result: The spiritual well-being of the hospice patients was higher than that of nonhospice patients(F=5.52, p=0.023). The global quality of life of the hospice patients was higher than that of nonhospice patients(F=8.84, p=0.004). There was a significant positive correlation between spiritual well-being and quality of life of the hospice patients and non hospice patients. Conclusion: The hospice care effects on spiritual well-being and quality of life of the terminal cancer patients.

  • PDF

간호학생의 임상실습 중 환자의 죽음 경험 (Nursing Students' Experiences with Patient Deaths during Clinical Practice)

  • 강현주;최혜정
    • 한국간호교육학회지
    • /
    • 제26권1호
    • /
    • pp.56-66
    • /
    • 2020
  • Purpose: The purpose of this study was to explore nursing students' experiences with patient deaths during clinical practice. Methods: The participants were ten nursing students who had experienced patient deaths during clinical nursing practice at a university hospital in Korea. Individual in-depth interviews were conducted, and the data were analyzed using the content analysis method suggested by Graneheim and Lundman (2004). Results: The participants' experience was structured into six categories: experiencing various emotions in facing patient deaths, viewing oneself as a nursing student at the scene of a patient's death, thinking about death again, finding a pathway of understanding and support for patient death experiences, impressions and regret felt while actually observing terminal care, and picturing oneself as a future nurse dealing with a patient's death. Conclusion: Based on this study, stress management and self-reflection programs are suggested for nursing students who have experienced patient deaths. Practical nursing education for patient death and end of life care is also needed.

말기 환자에서 사망 전 의료비 지출 현황과 환자관리 대책

  • 김기경
    • 호스피스학술지
    • /
    • 제5권1호
    • /
    • pp.26-32
    • /
    • 2005
  • Purpose: To know for what the medical expenditure had been used and to seek the way how it can be efficiently redistributed, I investigated total medical expenditure according to the time period to death in the expired patients for recent 2 years. Methods: 21patients were enrolled in this study. Total medical expenditure including benefit charge and non-benefit charge charged to patients in in-patient department(IPD) and out-patient department(OPD) was counted according to the period for one year by death. Results: 94.7% of the total medical expenditure had been payed for admission-related expenditure and 89% during period 3 and 4 for 6months before death, which may be due to the more days of admission during those periods. 70.1% of the total expenditure had been charged on the admission-fee, room charge, diet, and administration of the fluid, medicines, and blood etc. Conclusion: Majority of medical expenditure has been used in the affairs being unable to improve the survival or quality of life of patients and during the periods closer to death. Here, it would be needed heartily to look for the best ways in detail how the idea of hospice can come true through nation-wide and social consensus.

  • PDF

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

  • 김경운
    • 간호행정학회지
    • /
    • 제6권3호
    • /
    • pp.389-404
    • /
    • 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.

  • PDF