Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
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Ethical Attitudes according to Education and Clinical Experience of Do-Not-Resuscitate (DNR)

심폐소생술금지 교육 및 임상 경험에 따른 윤리적 태도

  • Kae, Young Ae (Department of Nursing, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Mi Yeon (Department of Biostatistics, Kangbuk Samsung Hospital) ;
  • Park, Jin Sook (Department of Nursing, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Hyo Joo (Department of Nursing, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jung, Tae Youn (Department of Nursing, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jang, Bo Young (Department of Nursing, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Yoon Jeong (Department of Nursing, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Koo, Dong-Hoe (Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 계영애 (성균관대학교 강북삼성병원 간호부) ;
  • 이미연 (강북삼성병원 통계지원실) ;
  • 박진숙 (성균관대학교 강북삼성병원 간호부) ;
  • 김효주 (성균관대학교 강북삼성병원 간호부) ;
  • 정태연 (성균관대학교 강북삼성병원 간호부) ;
  • 장보영 (성균관대학교 강북삼성병원 간호부) ;
  • 김윤정 (성균관대학교 강북삼성병원 간호부) ;
  • 구동회 (성균관대학교 강북삼성병원 혈액종양내과)
  • Received : 2015.03.24
  • Accepted : 2015.08.17
  • Published : 2015.09.01
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Abstract

Purpose: Although a Do-Not-Resuscitate (DNR) order is widely in use, it is one of the challenging issues in end-of-life care. This study was conducted to investigate attitudes toward DNR according to education and clinical experience. Methods: Data were collected using a structured questionnaire comprising 30 items in a tertiary hospital in Seoul, Korea. Results: Participants were 238 nurses and 72 physicians. Most participants (99%) agreed to the necessity of DNR for reasons such as dignified death (52%), irreversible medical condition (23%) and patients' autonomy in decision making (19%). Among all, 33% participants had received education about DNR and 87% had DNR experience. According to participants' clinical DNR experience, their attitudes toward DNR significantly differed in terms of the necessity of DNR, timing of the DNR consent and post-DNR treatments including antibiotics. However, when participants were grouped by the level of DNR education, no significant difference was observed except in the timing of the DNR consent. Conclusion: This study suggests that the attitudes toward DNR were more affected by clinical experience of DNR rather than education. Therefore, DNR education programs should involve clinical settings.

목적: 본 연구는 심폐소생술 비시행(DNR)에 관해 간호사와 의사의 DNR에 대한 인식 및 태도가 DNR 관련 교육 및 임상경험 여부에 따른 차이가 있는지 분석하고자 하였다. 방법: 연구대상은 단일대학병원에서 근무하는 간호사와 의사로서 총 310명이었으며, 자료수집 기간은 2013년 8월 19일부터 8월 30일까지였다. 연구도구는 DNR에 관해 간호사와 의사의 임상 경험과 윤리문제에 관한 인식 및 태도를 조사하기 위해 연구자들의 문헌고찰을 통해 30문항으로 구성된 설문지를 사용하였다. 결과: 본 연구의 참여자 중에 간호사는 238명(77%), 의사는 72명(23%)이었다. 대부분의 참가자들(99%)이 DNR의 필요성에 동의하였고 이유로는 환자의 편안하고 품위 있는 죽음(52%), 회복이 불가능한 의학적 상태(23%), 환자 본인의 죽음에 대한 선택(19%)의 순이었다. DNR 임상경험에 따른 차이는 DNR 필요성의 동의, DNR 시기 및 DNR 이후의 다른 치료의 허용에 대해서 차이를 보였다. 그러나 DNR 교육 여부에 따른 차이는 DNR 시기 이외에는 유의한 차이를 보이지 못하였다. 결론: 본 연구를 통해 DNR에 대한 교육보다는 임상에서의 경험이 실제 DNR에 대한 인식 및 태도에 유의한 영향을 미치는 것을 보여주었기에 효과적인 DNR 교육을 위하여는 실제 임상 실습을 통한 교육이 필요할 것으로 생각된다.

Keywords

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