• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.216-222
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• 2013

Purpose: The purpose of this study was to examine nurses' emotional responses and ethical attitudes towards elderly patients' Do-Not-Resuscitate (DNR) decision. Methods: Data were collected using a questionnaire which was filled out by 153 nurses who worked in nursing homes and general hospitals. Data were analyzed using real numbers, percentages, means, standard deviations and Pearson's correlation coefficients with SPSS 19.0 program. Results: The average score for ethical attitudes towards the DNR decision was 2.68 out of 4. Under the ethical attitudes category, the highest score was found with a statement that said 'Although they will not perform cardiopulmonary resuscitate (CPR), it is right to do their best with other treatments for DNR Patients'. Items regarding emotional responses to the DNR decision, the average score was 2.36 out of 4. Among them, the highest score was achieved on 'I understand and sympathize'. No significant correlation was found between ethical attitudes and emotional responses in relation to patients' DNR decision (r=-0.12, P=0.13). Conclusion: Regarding elderly patients' DNR decision, nurses showed somewhat highly ethical attitudes and slightly positive emotional response. A follow-up study is needed to investigate variables that affect our results.

• Journal of Hospice and Palliative Care
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• v.20 no.2
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• pp.93-99
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• 2017

Purpose: This study investigated changes in life-sustaining treatments in terminally ill cancer patients after consenting to a do-not-resuscitate (DNR) order. Methods: Electronic medical records were reviewed to select terminally ill cancer patients who were treated at the oncology unit of the Asan Medical Center, a tertiary hospital in South Korea and died between January 1, 2013 and December 31, 2013. Results: The median (range) age of the 200 patients was 59 (22~89) years, and 62% (124 persons) were male. Among all patients, 83.5% were aware of their medical condition, and 47.0% of the patients had their DNR order signed by their spouses. The median of the patients' hospital stay was 15 days, and time from admission to DNR decision was 10 days. After signing a DNR order, 35.7~100% of the life-sustaining treatments that had been provided at the time of the DNR decision making were administered. The most commonly discontinued interventions were transfusion (13.5%), blood test (11.5%) and parenteral nutrition (8.5%). Conclusion: It is necessary to define the scope of life-sustaining treatments for DNR patients. Treatment guidelines should be established as well to secure terminal patients' death with dignity after their consent to a DNR order, thereby avoiding meaningless life-sustaining treatments and allowing administration of active terminal care interventions.

• Journal of Hospice and Palliative Care
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• v.21 no.4
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• pp.115-123
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• 2018

Purpose: The purpose of this study was to identify how nursing students' awareness of biomedical ethics and ethical values affect their attitudes towards a do-not-resuscitate (DNR) order. Methods: This cross-sectional correlation study was conducted with 275 nursing students enrolled at two universities in North Chungcheong Province and North Gyeongsang Province of South Korea. Data were collected in April 2017 using a self-reported questionnaire. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient and stepwise multiple regression with the SPSS/WIN 23.0 program. Results: The students' attitudes towards DNR were positively correlated with attitudes that seek ethical values but negatively correlated with their biomedical ethics awareness. The explained variance for attitudes towards DNR was 20%, which was significant (F=13.01, P<0.001). Conclusion: These findings suggest that nursing students' biomedical ethics awareness and ethical values were associated with their attitudes towards DNR. Curriculum organization and various educational programs should be developed and applied to help nursing students develop ethical values and awareness of biomedical ethics.

• Journal of Korean Clinical Nursing Research
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• v.16 no.3
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• pp.73-84
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• 2010

Purpose: The purpose of this study was to investigate the ethical awareness and attitude of patients' families towards Do-Not-Resuscitate(DNR), and thus provide basic information required to develop Korean appropriate DNR instructions and practice informed consent for DNR. Methods: During April 2010, 219 patient family members visiting the hospital were surveyed using a questionnaire. Results: Most of the participants preferred DNR to meaningless treatment for incurable patients. They recognized the necessity of explaining DNR to the patient with a terminal disease. They also requested DNR orders for themselves if they were in the same medical condition. In making a DNR decision, the patient's family agreed and preferred that it reflect the opinion of the patient and the doctor in charge. They also agreed that treatment should be given with the best efforts even if a DNR decision had been made for the patient. Conclusion: To make a decision on DNR for a patient who is terminally ill or for whom survival is not possible, a practice of informed consent and guidelines for executing the DNR reflecting the patient's opinion are required.

• Korean Journal of Adult Nursing
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• v.25 no.3
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• pp.322-331
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• 2013

Purpose: This study was conducted to understand the meaning of the DNR experiences of nurses. Methods: The data were collected through in-depth interviews, observation, and field records with five nurses from November 2009 to February 2011. The data were analyzed using narrative inquiry methodology. Results: Three fundamental themes were derived from data analysis as following: 'faithfulness to care for comfort,' 'helping for peaceful farewells between the patient and the family,' 'reflecting one's lives with a collision of feeling toward the death.' Conclusion: The results indicate that nurses take a role of an advocate in caring for DNR patients and being concerned about their families' conflict and anguish. In addition, this study indicates the importance of education on living will, advanced directives and preparation for the death tailored to the public including healthcare professionals.

• Journal of Korean Academy of Nursing Administration
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• v.9 no.3
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• pp.447-458
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• 2003

Purpose: To examine the awareness and experiences of nurses and physicians on DNR. Method: The sample contained of 199 nurses and 98 physicians. The Instrument used in this study was The Nurses' Understanding and Attitude on DNR(AEDNR) developed by the Han et al and revised by the research the AEDNR included 29 items. Result: About 97.3% of them feel the necessity of DNR, Majority of subject(78.8%) have practiced DNR by the demand of 'the patient's family' and 91.8% of them made a medical record at the time they carried out DNR. There were no significant differences in their perceived necessity of DNR between nurses and physicians. Conclusion: This study can be a basis for making objective standards educational, ethical, and legal issues concerning DNR.

• Journal of Digital Convergence
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• v.13 no.11
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• pp.187-196
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• 2015

The purpose of this study was to examine the understanding of contents and the convenience of use of the DNR animation mobile electronic informed consent. The subjects in this study were inpatients of long-term care hospital. As for data analysis, a statistical package SPSS 21.0K was employed. The findings of the study were as follows: First, DNR choice was 33.0%, CPR choice was 54.0% in case of the outbreak of cardiac arrest. Their principal diagnosis made statistically significant differences to their choice of DNR and CPR. Second, they got 2.50 in the understanding of the content of the DNR electronic informed consent, and got 2.37 in the convenience of use. Given the findings of the study, the DNR animation electronic informed consent is expected to help patients to have a better understanding of contents, to make their decision to choose DNR or CPR, and to sign the DNR informed consent forms themselves.

• Journal of Hospice and Palliative Care
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• v.19 no.1
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• pp.26-33
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• 2016

Purpose: This study was conducted to identify clinical characteristics of oncologic patients at a point when they signed their do-not-resuscitate (DNR) orders. Methods: From January through December 2014, we retrospectively analyzed the records of 197 patients who passed away after agreeing to a DNR order in the hemato-oncology department of a tertiary hospital. Results: Of all, 121 patients (61.4%) were male and 76 (38.6%) were female, and their average age was 58.7 years. Ninety-four patients (47.7%) had gastrointestinal cancer. The ECOG performance status at admission was grade 3 in 76 patients (36.5%) and grade 4 in 11 (5.6%). The patients' mean hospital stay was 20 days. The mean duration from the admission to DNR decision was 13 days, and the mean duration from DNR decision to death was seven days. Conclusion: Study results indicate that a decision on signing or refusing a DNR order was made by medical staff mostly based on the opinions of patients' guardians rather than the patients themselves. This suggests that patients' own wishes are not well respected. Thus, it is urgent to establish institutional devices to enhance cancer patients' autonomy regarding DNR and to define an adequate timing for withdrawal of treatments.

• Journal of the Korea Convergence Society
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• v.10 no.6
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• pp.393-399
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• 2019

This is a descriptive study on the perception and attitude toward DNR in adults. Structured questionnaires were used and 210 subjects were studied. In recognition of DNR, DNR was helpful for 'a comfortable dying(64.3%)'. The need for DNR in situation investigated 'For dignified dying (41.3%)' and 'to alleviate patient suffering(23.9%)'. Respondents who do not agree with DNR are shown 'Because legal issues can arise(61.7%)', 'Because human dignity is the life-sustaining priority(16.7%)'. In the attitude toward DNR, the most significant result was 'I want to know if I have an incurable disease (4.21).' There was no difference in attitudes toward DNR among adults. The DNR is not a method of Withdrawing in lifeprolonging treatment, It should be addressed in a comprehensive context in which human beings exercise autonomy over the process of dying and death.

• Journal of Hospice and Palliative Care
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• v.18 no.3
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• pp.208-218
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• 2015

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.