• Journal of Hospice and Palliative Care
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• 제19권4호
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• pp.303-309
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• 2016

목적: 말기 암환자에서 악성 복수는 흔하게 발생하며, 그 자체가 나쁜 예후를 시사한다. 악성 복수에 대한 효과적이고, 최소한의 침습적인 방법으로 복수배액관 삽입이 제안되었다. 본 연구는 복수배액관 삽입을 시행한 말기 암환자들을 대상으로 복수배액관 시술의 효과와 부작용에 대하여 분석하고 시술 후 예후에 영향을 미치는 요인을 알아보기 위하여 시행되었다. 방법: 서울 소재 일개 3차 의료기관 호스피스 병동에 2010년 1월 1일부터 2013년 12월 31일까지 입원한 말기 암환자 2,608명 중 복수배액관 삽입을 시행한 67명의 환자들의 의무기록을 조사하였다. 인구학적 정보, 완화의료 수행지수, 혈액검사, 복수 배액관 유지 기간, 시술 합병증의 종류와 빈도, 항생제 사용 여부와 기간, 시술 후 생존기간을 분석하였다. 복수 배액관 삽입 후 생존기간에 영향을 미치는 요인을 평가하기 위해 단변량 및 다변량 콕스 비례위험 회귀분석을 실시하였다. 결과: 총 67명의 연구대상자 중 원발암은 간암 및 담도암과 위암이 가장 흔하였다. 복수배액관 시술 후 복수관련 증상의 호전은 55명(82.1%)에서 있었다. 시술 후 합병증은 통증(19.4%), 누수(14.9%), 배액관 빠짐(7.5%), 배액관 막힘(6%), 발열(4.5%)이었다. 복수배액관 시술 후 생존기간에 영향을 주는 인자는 다변량 콕스 비례위험 회귀분석 결과 완화의료 수행지수(HR 0.73; P=0.045), 저나트륨혈증(HR 2.77; P=0.003)이었다. 결론: 복수를 동반한 말기 암환자에서 복수 배액관 시술 시, 완화의료 수행지수와 저나트륨혈증은 예후 인자로 사용될 수 있을 것이다. 추후 대규모의 전향적 연구가 요구된다.

• Journal of Hospice and Palliative Care
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• 제11권2호
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• pp.78-81
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• 2008

목적: 인생의 말기는 삶을 영위하는 가운데 가장 중요한 부분 중의 한가지이다. 그런데 의사, 간호사를 포함한 의료진과 자원봉사자가 말기 환자에 대한 이해와 교육이 충분하게 이루어지지 않고 있다. 이 연구의 목적은 호스피스 완화의료의 꽃으로 알려진 자원봉사자들에 대한 교육내용을 비교하고자 한다. 방법: 다양한 기관에서 자원봉사자들에 대한 교육이 실시하고 있으나 강의 내용과 강의 시수를 알 수 있는 전국 9개 기관의 교육내용을 분석 비교하였다. 결과: 평균 강의 시간은 21.56 ($14{\sim}30$)시간이었으며, 모든 기관에서 공통적으로 포함된 교육 내용은 호스피스 완화의료의 이해, 삶과 죽음에 대한 이해, 호스피스 대상자의 심리 이해 등이며, 온라인을 통한 교육이 1개 기관, 나머지 8개 기관에서는 집체교육을 통한 강의를 위주로 시행되고 있다. 결론: 자원봉사자들의 지역사회 참여의 활성화를 도모하여 말기 환자와 가족에게 제공되는 서비스를 질적으로 강화시키기 위하여 자원봉사자를 위한 교육과정의 목표와 교육내용, 교육시간, 교육기관으로서의 인정평가 등에 대한 전반적인 표준화가 필요할 것으로 생각된다.

• 가정간호학회지
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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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• 제18권3호
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• pp.179-187
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• 2015

환자가 죽음에 임박했을 때 환자, 보호자, 의사 사이에서 심폐소생술에 대한 논의는 피할 수 없는 주제이다. 환자가 회복 불가능한 말기의 암환자인 경우에는 환자의 품위 있는 죽음을 고려하여 심폐소생술을 시행하지 않음(Do-not-resuscitate, DNR)을 결정하게 된다. 그러나 DNR에 대한 선택은 환자와 보호자의 심폐소생술과 DNR의 의미 및 그 결과에 대한 이해를 바탕으로 한다. DNR에 대하여 환자, 보호자, 의료진이 상담을 할 때는 환자의 질환이 더 이상 치료가 불가능하며, 심폐소생술이 환자의 생명을 연장시키는 것이 아니라 죽음의 과정을 연장시키는 것이며, 심폐소생술 이후에 삶의 질이 급격히 나빠질 수 있는 상황이라는 합의가 필요하다. 충분한 이해는 환자 또는 보호자가 품위 있는 죽음을 위한 DNR을 선택하도록 한다. 국내에서는 DNR 자체 보다는 이미 생명유지장치를 가지고 있는 환자에서의 생명유지장치의 제거에 대한 법적인 문제가 2차례 발생하면서 사회적으로 품위 있는 죽음에 대한 일반 대중의 관심이 이전보다 증가하였다. 환자와 의료진을 대상으로 한 설문에서는 DNR에 대한 인식과 의지가 80년대에 비해 2000년대 초반에 이르러 상당히 증가하였으나, 실제 의료 현장에서는 DNR의 결정에 있어 환자가 직접 관여를 하는 경우는 많지 않았고 DNR 작성 시점과 사망 시점과의 시간 간격이 1주 이내로 환자가 관여를 하거나 임종시기의 의료를 결정하기에는 너무 짧은 문제가 있었다. 이러한 문제는 조기 완화의료의 확산을 통하여 개선이 가능할 것으로 생각된다. 일부에서는 DNR이라는 용어보다는 자연적인 죽음을 허용함(Allow-Natural-Death)이라는 용어로 바꾸어서 설명하는 것이 이해를 돕고 선택의 갈등을 줄인다는 보고를 하여 DNR 논의와 결정에 있어서 적절한 시기 이외에도 환자와 보호자에게 많은 어려움이 있다는 것을 보여 주고 있다. DNR은 말기암환자에서 품위 있는 죽음을 위해 고려해야 하는 사항이며, 임상에서 DNR이 잘 시행되도록 임상적, 제도적 노력이 필요하다.

• 임상간호연구
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• 제14권2호
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• pp.103-114
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• 2008

Purpose: The purpose of this study was to investigate the level of QoL of the terminal cancer patients at home and to identify any influencing factors on QoL. Method: Subjects of this study consisted of 72 terminal cancer patients who were receiving home care nursing for more than 2 weeks in 6 general hospitals. Data were collected by a self-reporting questionnaire on QoL, pain, physical functioning, and symptom experience from Feb, 2006 to Dec, 2006. Data were analyzed by t-test, one way ANOVA, Pearson correlation coefficients, and multiple regression using SPSS Win 14.0. Results: Mean score of QoL was 98.6(230 in total). Except the level of family coping, general characteristics and disease related variables did not show significant difference in QoL. QoL was higher in the family with better coping, and QoL showed negative correlation with three types of pain, physical functioning, and symptom experiences. Least pain, physical functioning, and level of family coping explained QoL up to 26.7%. Conclusion: The QoL was closely related with pain, physical functioning, symptom experience, and family coping. And the least pain, physical functioning and level of family coping were important factors influencing on QoL of terminal cancer patients. However, some other variables influencing the QoL need to be investigated in the future.

• 대한간호학회지
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• 제35권3호
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• pp.441-450
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• 2005

Purpose: The purposes of this study were to determine the core nursing interventions in nursing notes and the practice which was perceived by nurses of an oncology unit with patients with terminal cancer. Also, comparing interventions in nursing notes with interventions in perceived practice was done. Method: Subjects were 44 nursing records of patients with terminal cancer who had died from Jan. to Dec. 2002 at C University Hospital and 83 nurses who were working on an oncology unit for more than one year. Data was collected using a Nursing Interventions Classification and analyzed by means of mean and t-test. Results: The most frequent nursing intervention was 'nausea management' in the nursing note and was 'medication administration: oral' in perceived practice. The frequency of nursing interventions in the nursing record was lower than in perceived practice. Conclusion: This study finds that nurses actually practice nursing care, but they may omit records. To correct for omitted nursing records, development of a systematic nursing record system, continuous education and feedback is recommended.

• 대한간호학회지
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• 제32권2호
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• pp.243-253
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• 2002

The purpose of this study was to develop Nurse's Suffering Experience Scale and to test the reliability and validity of the instrument. Method: The subjects used to verify the scale's reliability and validity were 220 nurses who were taking care of the end stage cancer patients, while working at university and general hospitals in Daegu and Kyungbuk province from April 20. to July 10, 2001. The data was analyzed by the SPSS/WIN 8.0 program. Results: A factor analysis was conducted, and items that had a factor loading more than .40, and an eigen value more than 1.0. were selected. The factor analysis classified a total of seven factors statistically, and it's communality was 44%. The explanation of factors based on the conceptual framework and item content are as follows: The first factor was expanding self consciousness, the second factor was forming empathy with family, the third factor was professional challenge, the fourth factor was change of values, the fifth factor was spiritual sublimation, the sixth factor was helplessness, and finally the seventh factor was rejection to death. Cronbach's coefficient to test reliability of the scale was .8665 for total of 44 items. The Scale for Nurse's Suffering Experience developed in the study was identified as a tool with a high degree of reliability and validity. Therefore this scale can be effectively utilized for the evaluation of the degree of nurse's suffering experience in clinical settings.

• 지역사회간호학회지
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• 제23권2호
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• pp.127-133
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• 2012

Purpose: This study was conducted to assess needs at each end-of-life care stage and to analyze importance and difficulty of care needs for home care nursing among non-cancer patients. Methods: We used a retrospective design. Total eligible patients were 117 at the ages of 40 and over, who continuously received home care nursing throughout beginning, stable, and near death stages, and finally died at home from January 1, 2006 to December 31, 2006. Descriptive statistics, Cochran's Q test, Friedman's test were used for data analysis. Results: In the area of physical care, the care need for 'assistance for activities in daily life' was significantly highest in the beginning stage. The care need for 'aggravation or adverse changes in physical symptoms' was significantly increased in the near death stage. In the area of psychospiritual care, 'family's psychological burden' was revealed as having the highest rate of care needs in the every stage. Conclusion: Future intervention should consider assessing care needs in end-of-life care for non-cancer patients who are provided with home care nursing.

• 종양간호연구
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• 제8권1호
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• pp.32-39
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• 2008

Purpose: This study was to identify the relationship between perceived family support and quality of life in hospitalized patient with terminal cancer. Method: Study subjects were 104 patients with terminal cancer who were hospitalized and treated at K university hospital, in Busan. Perceived family support and quality of life were measured using the Kang's Revised Family Support Scale and Youn's Quality of Life scale for terminal patients. Results: 1) The mean score of perceived family support was $4.23{\pm}0.61$. The mean score of quality of life was $5.83{\pm}1.37$. 2) The perceived family support was significantly different with primary care giver, food type, medical period after diagnosis. 3) The levels of quality of life was significantly different by number of children, effect of religion on the one' life, perceived state of disease and pain. 4) There was moderate positive correlation between perceived family support and quality of life. Conclusions: Increase in perceived family support was associated with increase in quality of life in hospitalized patients with terminal cancer. It is necessary that the development of nursing education program for family which help to support the patient with terminal cancer for increasing the quality of life of patient with terminal cancer.

• 대한간호학회지
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• 제36권2호
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• pp.299-309
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• 2006

Purpose: The main purpose of this study was to develop a substantive theory on the process of the spiritual experience in Christian terminal cancer patients in the context of Korean society and culture. The question for the study was 'What is the spiritual process in Christian terminal cancer patients?'. Method: The research method used was the Grounded Theory Method developed by Strauss & Corbin(1998). Participants for this study in total were 9 Christian terminal cancer patients. Data was collected using in-depth interviews during April 2003 to March. 2004. Data collection and analysis were carried out at the same time. Result: From the analysis 58 concepts and 20 categories emerged. The categories were presented into a paradigm, which consisted of condition-actions/interactions-consequences. The theoretical scheme was described by organizing categories. In total, 4 stages were developed from the condition-actions/ interactions-consequences. Throughout these stages, the 'overcoming process of unbalanced interconnectedness' was the core category discovered. Conclusion: This study provides a framework for the development of individualized care interventions in the 'overcoming process of unbalanced interconnectedness' for Christian terminal cancer patients.