• 의료법학
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• 제14권1호
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• pp.355-401
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• 2013

The first legislation for terminal health-care decision was California's Natural Death Act (NDA) of 1976 that permitted any adult person to execute a directive directing the withholding or withdrawal of life-sustaining procedures. Advance directive legislation has subsequently progressed on a state-by-state basis. By 1992, all 50 states, as well as the District of Columbia, had passed legislation to legalize some form of advance directive. This state legislation, however, has resulted in an often fragmented, incomplete, and sometimes inconsistent set of rules. Statutes enacted within a state often conflict and conflicts between statutes of different states are common. In an increasingly mobile society where an advance health-care directive given in one state must frequently be implemented in another, there is a need for greater uniformity. In 1993, the Uniform Law Commissioners approved the Uniform Health-Care Decisions Act (UHCDA) in order to bring order to the existing chaos. Unfortunately, the Commissioners waited too long to act. By the time the UHCDA was approved, nearly all states had passed legislation governing advance directives. Consequently, the UHCDA has achieved only a limited success, picking up but one or two enactments a year. The UHCDA is currently in effect in around 10 states: Alabama, Alaska, California, Delaware, Hawaii, Kansas, Maine, Mississippi, New Mexico, Tennessee, Wyoming. In these states the previous laws related to the subjects have been all repealed. The overall objective of the UHCDA is to encourage the making and enforcement of advance health care directives including living will or individual instruction, power of health-care attorney and to provide a means for making health care decisions for those who have failed to plan. The U. S. House of Representatives in 1991 enacted the Patient Self-Determination Act (PSDA). The Act stipulates that all hospitals receiving Medicaid or Medicare reimbursement must ascertain whether patients have or wish to have advance directives. The Patient Self- Determination Act does not create or legalize advance directives; rather it validates their existence in each of the states. Now in America, terminal health-care decision or advance directive for health care is common and universal system. The problem, however, is how to let more people use these good tools to make their lives more beautiful and honorable.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7309-7314
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• 2013

Aim: To investigate factors that affect the place of death (POD) of terminal cancer patients. Materials and Methods: We recruited 702 consecutive patients (${\geq}18$ years) from 12 centers during July 2005 to October 2006, and 481 completed the questionnaire. In April 2011, we linked the data for 96.0% (n=462) of the deceased patients to the POD using the 2005-2009 death certificate data of Korea's National Statistical Office. The primary outcome variable was POD, and the predictive value of variables pertaining to patients and caregivers was evaluated using univariate and multivariate analyses. Results: Most patients died in a hospital (91.5%, n=441) and age, education, preference for place of terminal care, wish to use hospice/palliative care services, terminal cancer awareness, time between diagnosis and death, and global quality-of-life subscale of the EORTC QLQ-C30 of patients, and education and preference for place of terminal care of caregivers were significant predictors in univariate analyses. On multivariate analysis, patients and caregivers who preferred hospital/palliative care as the terminal care option over home care [adjusted odds ratio (aOR), 2.68; 95% confidential interval (CI), 1.18-7.04 and aOR: 2.65; 95%CI: 1.15-6.09 for patient and caregiver preferences, respectively] and caregivers who were highly educated (aOR, 3.19; 95%CI, 1.44-7.06) were predictors of POD. Conclusions: Most of the terminal cancer patients died in a hospital. Our findings indicate that major predictors of hospital deaths are preference of both the patient and caregiver for hospital/palliative care as the terminal care option and higher education of the caregiver.

• International journal of advanced smart convergence
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• 제5권1호
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• pp.1-7
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• 2016

Recently, introduced a cloud computing technology to the IT industry, smart phones, it has become possible connection between mobility terminal such as a tablet PC. For dissemination and popularization of movable wireless terminal, the same operation have focused on a viable mobile cloud in various terminal. Also, it evolved Wireless Sensor Network(WSN) technology, utilizing a Body Sensor Network(BSN), which research is underway to build large Ubiquitous Sensor Network(USN). BSN is based on large-scale sensor networks, it integrates the state information of the patient's body, it has been the need to build a managed system. Also, by transferring the acquired sensor information to HIS(Hospital Information System), there is a need to frequently monitor the condition of the patient. Therefore, In this paper, possible sensor information exchange between terminals in a mobile cloud environment, by integrating the data obtained by the body sensor HIS and interoperable data DBaaS (DataBase as a Service) it will provide a base of mBodyCloud System. Therefore, to provide an integrated protocol to include the sensor data to a standard HL7(Health Level7) medical information data.

• 가정∙방문간호학회지
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• 제26권2호
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• pp.180-188
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• 2019

Purpose: To investigate the duration of each nursing activity performed by home care nurses for non-cancer patients and the relationship between patients' palliative prognostic index (PPI) and duration of each nursing activity. Methods: Nursing activities performed for six non-cancer terminal patients were timed using a stopwatch, and 18 parameters were measured by visiting each patient thrice. The mean and standard deviations of duration for each category of nursing activities were computed. The relationship between category-specific duration of nursing activities and PPI was analyzed with Spearman's correlation and multiple regression analysis. Results: Among nursing activities, the highest greatest duration of time was spent on traffic time (11.91 min), followed by urinary catheter management (10.65 min) and insertion and management of nasogastric tube (9.03 min). In terms of nursing categories, after excluding movement time, the greatest duration of time was spent on excretion care (5.48 min), nutrition care (5.40 min), and medication (3.82 min). PPI correlated with hygiene care, excretion care, and patient and information management. Multiple regression analysis revealed that PPI increased with increasing duration of hygiene care. Conclusion: These study findings provide grounds for the increased nursing time of hygiene care for people reaching the end of life.

• Journal of Hospice and Palliative Care
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• 제9권2호
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• pp.106-111
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• 2006

목적: 말기 암환자에서 마약성 진통제를 사용한 통증 조절과 호스피스를 통한 보존적 치료는 매우 유용한 치료 방법이다. 그러나 많은 환자들과 환자의 보호자들은 중독과 내성에 대한 두려움 때문에 마약성 진통제의 사용을 충분히 하지 못하고 있다. 그리고 또한 다수의 환자와 보호자들은 호스피스가 환자의 상태가 돌이킬 수 없는 지속적으로 악화되는 것과 같이 생각하기 때문에 호스피스를 받아들이는 것을 꺼려한다. 이 연구의 목적은 한국 문화에서 가족구성원이 건강관리에 결정적인 역할을 하기 때문에 말기 암 환자의 보호자들의 호스피스와 마약성 진통제의 사용에 대한 인식도를 분석하고 평가하였다. 방법: 이 연구에서는 총 54명의 말기 암환자의 보호자들이 참가했다. 설문지는 총 마약성 진통제와 호스피스에 관한 15문항으로 구성되었다. 결과: 연구는 다음과 같은 결과를 나타내었다. 1) 환자보호자의 반 이상(56.7%)이 호스피스에 대한 인식이 없었다. 2) 환자 보호자의 81.8%가 호스피스 치료가 말기 암환자에게 유익하다는 데 동의했다. 3) 보호자의 85.1%는 경제적 부담을 갖고 있었다. 4) 환자의 83.2%가 24시간 동안 통증의 호소했다. 5) 보호자의 85.8% 마약성 진통제가 통증을 조절할 수 있음을 믿고 있었으나 또한 79.1%와 79.6%보호자들은 마약성 진통제의 사용이 중독과 내성을 발생시킨다고 믿었다. 결론: 여전히 통증 조절을 위한 마약성 진통제 사용에 있어 보호자의 벽이 존재했다. 또한 말기 암 환자 보호자에게 호스피스에 대한 정보가 부족했다. 그러므로 약사와 의사 의한 마약성 진통제에 대한 교육이 통한 말기암환자에 있어 적절한 통증 조절을 위해 필요하다. 그리고 호스피스에 대한 좀 더 정확한 정보를 말기 암 환자에게 제공하여야 한다.가족간병인의 삶의 질에 많은 영향을 주는 교정 가능한 인자로 나타났다. 말기 암 환자 간병인의 간병 시간 및 경제적 부담을 감축하기 위한 사회적 지원이 필요하다. 봉사자와의 관계는 매우 좋다가 81.2%로 대부분을 차지하였고, 병원직원과의 관계는 매우 좋다가 69.7%였고, 다음은 대체로 좋다가 21.2%의 순이었다. 봉사활동에 대해 가족이나 친구의 지지는 어떠한가는 매우 좋다가 83.2%로 대부분을 차지하였다. 2. 대상자의 자원봉사활동 만족도는 평점 $3.09{\pm}0.49$(도구범위 $1{\sim}4$점)로 중간정도이었다. 영역별로 살펴보았을 때 만족도가 가장 높았던 영역은 사회적 접촉영역($3.48{\pm}0.61$)이었고, 다음은 성취영역($3.43{\pm}0.53$), 사회적 인정영역($3.35{\pm}0.70$)의 순이었다. 만족도가 가장 낮았던 영역은 사회적 교환영역($1.65{\pm}0.63$)이었다. 3. 대상자의 인구사회학적 특성에 따른 봉사활동 만족도를 분석한 결과 성별(t=2.038, P=0.044), 결혼상태(F=3.806, P=0.013)에 따라 유의한 차이를 보였다. 4. 대상자의 자원봉사활동 실태에 따른 봉사활동 만족도를 분석한 결과병원봉사활동기간(F=3.326, P=0.008), 봉사활동을 하는 주된 이유(F=2.707, P=0.035), 봉사활동을 위한 교육을 받은 여부(t=-1.982, P=0.050), 봉사활동의 평가 빈도(F=7.877, P=0.000), 봉사활동이 자신의 기술이나 능력에 적합도(F=2.712, P=0.049), 관리자와의 관계(t=-2.517, P=0.013), 다른 병원직원과의

• Journal of Hospice and Palliative Care
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• 제18권4호
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• pp.267-275
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• 2015

목적: 내과병동 간호사들의 임종간호 스트레스, 직무 만족도와 임종간호수행을 파악하고 이들의 관계를 규명하여 내과병동 간호사의 임종간호수행을 증진시킬 수 있는데 필요한 기초 자료를 마련하고자 함이다. 방법: B광역시와 P시에 소재한 3개의 대학병원과 3개의 종합병원에서 임종환자 경험이 있는 1년 이상 근무한 내과병동 간호사 201명을 분석하였다. 2014년 3월 1일부터 3월 31일까지 31일간 이었으며, K대학교 생명윤리위원회의 승인을 받은 후 구조화된 자기기입형 설문지를 사용하였고, SPSS/PC 17.0 통계 프로그램을 이용하여 분석하였다. 결과: 대상자의 임종간호 스트레스 정도와 직무만족도 정도의 관계는 미약한 역상관관계(r=-212, P=0.003)가 있는 것으로 나타났고 직무만족도 정도는 임종간호수행 정도의 관계에서 미약한 순상관관계(r=0.383, P<0.001)를 보였다. 임종간호 스트레스 정도와 임종간호수행 정도의 관계는 유의한 상관관계가 없는 것으로 나타났다. 결론: 임종간호수행을 잘 하도록 직무만족도를 높이기 위한 방안이 필요할 것으로 생각된다.

• Journal of Hospice and Palliative Care
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• 제1권1호
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• pp.65-68
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• 1998

The neuropathic pains are not well controlled by common analgesics and opioid drugs in terminal cancer patients. The types of these pains are divided within the two cages, one is due to continuous central sensitization and the other is due to paroxymal peripheral sensitization. The mechanism of continuous central sensitization is the activity of dorsal horn neurones that are activated by C-fiber input. The tricyclic antidepressants, non-tricyclic antidepressants, and oral local anaesthesia probably produce analgesic effects in neuropathic pains through suppression of this activity. The mechanism of paroxymal peripheral sensitization is the hyper-excitability of peripheral neurones. The neuropathic pains due to peripheral sensitization respond relatively the anticonvulsants and baclofen that stabilize membranes and suppress paroxymal electrical discharge. The patients was a 38-year-old female who complained of hyperthemia on upper right extremity. The symptom of this patient was improved with anticonvulsant(dilantin 600mg).

• Journal of Chest Surgery
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• 제9권1호
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• pp.41-43
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• 1976

Primary tumors of trachea are rather uncommon, and few cases of direct surgical excision were reported in the literature. Recently we had the opportunity to see a patient with a benign obstructing tumor of the trachea which was confirmed as fibroma. The patient has complained of intermittent dyspnea, especially during inspiratory phase, dry cough and wheezing of a strident character for last 8 years. Bronchoscopy or bronchography were not attempted because of severe dyspnea. Trachea tomogram revealed oval mass at the terminal trachea. The right posterolateral thoracotomy was performed. Tumor, $2.5{\times}1.7cm$ in size, was located at terminal trachea and removed through right lateral tracheotomy without difficulty. Postoperatively all the symptoms and signs disappeared.

• 대한간호학회지
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• 제31권6호
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• pp.1055-1066
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• 2001

The Purpose of this study is to understand the meaning and the essence of suffering as viewpoint and to find the meaning and structure of the experience from encounters with patients in their terminal stages of illness. Method: A descriptive design based on the phenomenological approach model developed by Collaizzi was used. The period of data collection was from August to November of 2000. Data collection was conducted by open-ended and audio-taped interviews. The participants were nine female nurses who were willing to take part in this study. Results: Results of this study were classified into five main categories. The main category clusters were "difficulty in experiencing suffering," "professional challenges to expert nurses," "formation of empathic relationships," "expanding consciousness through suffering," and "alleviation of the patient's suffering." Conclusion: In conclusion, the implications for providing nursing care to end-stage patients in the throes of suffering is both rewarding and stressful. However, sharing these research results may help other nurses discover and experience deeper meanings in their own practice and careers.deeper meanings in their own practice and careers.

• 한국간호교육학회지
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• 제23권1호
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• pp.37-47
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• 2017

Purpose: This study aimed to explore the influences of attitude to death and resilience on terminal care attitude among Korean nursing students. Methods: Participants were 230 nursing undergraduates from two nursing schools in Korea. The students responded to a self-report questionnaire that included demographics, attitude to death, resilience, and terminal care attitude. Results: The majority of the participants who had undertaken a clinical practicum had experienced the death of a patient during their clinical placements but had not yet received any support from their instructors or professionals, but also academic training on patients' death or terminal care. The mean score of terminal care of the students who had death-related education was significantly higher than among those who had not. Regression analysis indicated that attitude to death, grade, and resilience were the most significant predictors of terminal care attitude. These explained 30.3% of their terminal care attitude. Conclusion: Death-related education is needed throughout the curriculum including not only death but also resilience to develop emotional competences. In this way, nursing undergraduates will be better prepared to cope positively and constructively with the suffering and death they encounter, and thus may minimize the distress they experience in the patients' dying process. It may also create a significant positive increase in their terminal care attitude.